Antithrombotic and Thrombolytic Therapy: From Evidence to Application

Schünemann, Holger J.; Cook, Deborah J.; Grimshaw, Jeremy; Liberati, Alessandro; Heffner, John E.; Tapson, Victor F.; Guyatt, Gordon

doi:10.1378/chest.126.3_suppl.688s

Cited by 67 publications

(11 citation statements)

References 61 publications

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“…Finally, consideration of patient values and preferences in addition to scientific evidence was introduced in the American College of Chest Physicians VTE guidelines in 2004. 23 Although we agree that patients should be aware of the magnitude of harm resulting from ISH expansion, the lack of scientific evidence regarding the baseline rate of ISH expansion and the effect of VTE prophylaxis on this risk was one of the primary motivators for this study.…”

Section: Discussionmentioning

confidence: 94%

Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury

Chang

Scerbo

Schmitt

et al. 2017

J Trauma Acute Care Surg

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Background After traumatic spinal cord injury (SCI), there is increased risk of venous thromboembolism (VTE), but chemoprophylaxis (PPX) may cause expansion of intraspinal hematoma (ISH). Methods Single-center retrospective study of adult trauma patients from 2012–2015 with SCI. Exclusion criteria: VTE diagnosis, death, or discharge within 48 hours. Patients were dichotomized based on early (≤48 hours) heparinoid and/or aspirin PPX. ISH expansion was diagnosed intraoperatively or by follow-up radiology. We used multivariable Cox proportional hazards to estimate the effect of PPX on risk of VTE and ISH expansion controlling for age, ISS, complete SCI, and mechanism as static covariates and operative spine procedure as a time-varying covariate. Results 501 patients with SCI were dichotomized into early PPX (n=260, 52%) and no early PPX (n=241, 48%). Early PPX patients were less likely blunt-injured (91% vs 97%) and had fewer operative spine interventions (65% vs 80%), but age (median 43 vs 49 years), ISS (median 24 vs 21), admission ISH (47% vs 44%), and VTE (5% vs 9%) were similar. Cox analysis found that early heparinoids was associated with reduced VTE (HR 0.37, 95% CI 0.16–0.84) and reduced pulmonary embolism (PE) (HR 0.20, 95% CI 0.06–0.69). The estimated number needed to treat with heparinoids was 10 to prevent one VTE and 13 to prevent one PE at 30 days. Early aspirin was not associated with reduced VTE or PE. Seven patients (1%) had ISH expansion, of which 4 were on PPX at time of expansion. Using heparinoid and aspirin as time-varying covariates, neither heparinoids (HR 1.90, 95% CI 0.32–11.41) nor aspirin (HR 3.67, 95% CI 0.64–20.88) was associated with ISH expansion. Conclusion Early heparinoid therapy was associated with decreased VTE and PE risk in SCI patients without concomitant increase in ISH expansion. Level of Evidence Level IV (Therapeutic)

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Section: Discussionmentioning

confidence: 94%

Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury

Chang

Scerbo

Schmitt

et al. 2017

J Trauma Acute Care Surg

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“…The implementation science literature was used to inform the selection of these interventions. Implementation research is the scientifi c study of interventions to promote the systematic uptake of clinical research fi ndings into routine clinical practice (Schünemann et al, 2004) and a number of benefi cial interventions have previously been studied including educational outreach, reminders, educational meetings, audit and feedback, and the provision of educational materials Grol, Eccles, & Wensing, 2005;Ostini et al, 2009;Schünemann et al, 2004). The interventions selected for this project are listed and discussed below:…”

Section: Project Interventionsmentioning

confidence: 99%

“…This served two important functions: First, it provided a measure of the impact of the various project interventions, and second, it enabled regular feedback to the various clinicians thereby providing an ongoing motivation to change their practice. Audit and feedback is one of the most effective strategies for producing behavioural change in clinicians both on its own and when used, as in this project, as part of a suite of interventions National Health & Medical Research Council [NHMRC], 2000;Schünemann et al, 2004;Tooher et al, 2005).…”

Section: Audit and Feedbackmentioning

confidence: 99%

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Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: A multidisciplinary practice improvement project

Duff

Walker

2010

Contemporary Nurse

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“…Hence, antithrombotic therapy is commonly used in cardiovascular disease [14][15][16]. Unfortunately, the benefits of this therapy are limited, and an important proportion of treated patients will suffer a new thrombotic event.…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetics in Cardiovascular Antithrombotic Therapy

Marı́n

Roldán²,

Gónzález-Conejero³

et al. 2005

CMCCHA

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Thrombosis is the most important underlying mechanism of coronary heart disease and embolic stroke. Therefore, antithrombotic therapy is commonly used in cardiovascular diseases. Unfortunately, the benefits are limited, and an important proportion of treated patients will suffer a new thrombotic event. Lack of clinical benefits may be related to heterogeneous response to antithrombotic treatment among individuals (inter-individual heterogeneity). Few factors have been identified to be involved in this inter-individual heterogeneity. Recently, pharmacogenetic has emerged as a new field in medicine that tries to identify gene variants able to explain the heterogeneity in patient's response to a drug. Polymorphisms affecting disposition, metabolism, transporters or targets of the drug could modify the individual response to one therapy, and probably its side effects. The present review article explores the genetic influence on antithrombotic drug efficacy, analysing the modulating role of different polymorphisms on individuals' response to drugs commonly used in current day practice.

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Antithrombotic and Thrombolytic Therapy: From Evidence to Application

Cited by 67 publications

References 61 publications

Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury

Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury

Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: A multidisciplinary practice improvement project

Pharmacogenetics in Cardiovascular Antithrombotic Therapy

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