Do anticoagulants improve survival in patients presenting with venous thromboembolism?

Kelly, James; Hunt, Beverley J.

doi:10.1111/j.1365-2796.2003.01206.x

Cited by 15 publications

(8 citation statements)

References 111 publications

(142 reference statements)

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“…Pooled data from a number of such studies containing several thousand patients with clinical PEs and DVTs (which are proximal in most cases 17,18 ) show that the overall risks of fatal PE in untreated PE (recognized and in whom survival to the point of diagnosis occurred) and treated PE were 26.6% and 2.6%, respectively, with corresponding figures for proximal DVT (PDVT) of 16.2% and 0.7%. Recurrent nonfatal PE occurred in 12.8% and 15.1% of untreated patients presenting with PE and DVT, respectively 19 (see the Figure). Two caveats should be kept in mind when these data from the preimaging era are interpreted.…”

Section: Morbidity and Mortality Associated With Untreated Clinical Vmentioning

confidence: 98%

Anticoagulation or Inferior Vena Cava Filter Placement for Patients With Primary Intracerebral Hemorrhage Developing Venous Thromboembolism?

Kelly

Hunt

Lewis

et al. 2003

Stroke

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Background-Most patients with primary intracerebral hemorrhage developing clinically apparent proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE) require treatment with either anticoagulants or inferior vena cava filter insertion. Although the latter probably reduces the immediate risk of incident or recurrent PE and surmounts the undefined risk of recurrent intracranial bleeding with anticoagulation, the issue of preventing further thrombus propagation is not addressed, and there are associated short-and long-term risks, including a greater incidence of recurrent DVT. Summary of Review-There are no data from randomized trials to clarify optimum treatment in these patients; indeed, the feasibility of such studies is questionable. Hence, treatment decisions continue to be made on an individualized basis and should include assimilation of information on key factors such as time elapsed post-stroke and lobar versus deep hemispheric location of the index event, natural history studies demonstrating a two-fold risk of recurrent intracerebral hemorrhage in the former subgroup. Conclusions-In patients selected for anticoagulation, data from nonstroke patients suggest that a 5-to 10-day course of full-dose low-molecular-weight heparin followed by 3 months of lower-dose low-molecular-weight heparin is at least as effective as warfarin and may be associated with fewer hemorrhagic complications.

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Section: Morbidity and Mortality Associated With Untreated Clinical Vmentioning

confidence: 98%

Anticoagulation or Inferior Vena Cava Filter Placement for Patients With Primary Intracerebral Hemorrhage Developing Venous Thromboembolism?

Kelly

Hunt

Lewis

et al. 2003

Stroke

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“…To reduce the risk of recurrent DVT, postthrombotic syndrome, and development of PE, intravenous or subcutaneous heparin therapy should be immediately initiated and, subsequently, replaced by treatment with oral warfarin for a period of time ranging from 6 weeks to 6 months. 46,57 Given that the use of anticoagulation treatment involves a relatively significant risk of hemorrhage, clinicians need to weigh the potential benefits and risks for each patient in the process of decision making. 44,67 When acute PE is diagnosed, the patient should be treated with parenteral anticoagulation therapy unless it is contraindicated.…”

Section: Management Of Vte After Acute Scimentioning

confidence: 99%

Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management

Furlan

Fehlings

2008

FOC

247

153

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Cardiovascular complications in the acute stage following traumatic spinal cord injury (SCI) require prompt medical attention to avoid neurological compromise, morbidity, and death. In this review, the authors summarize the neural regulation of the cardiovascular system as well as the pathophysiology, diagnosis, and management of major cardiovascular complications that can occur following acute (up to 30 days) traumatic SCI. Hypotension (both supine and orthostatic), autonomic dysreflexia, and cardiac arrhythmias (including persistent bradycardia) are attributed to the loss of supraspinal control of the sympathetic nervous system that commonly occurs in patients with severe spinal cord lesions at T-6 or higher. Current evidence-based guidelines recommend: 1) monitoring of cardiac and hemodynamic parameters in the acute phase of SCI; 2) maintenance of a minimum mean arterial blood pressure of 85 mm Hg during the hyperacute phase (1 week after SCI); 3) timely detection and appropriate treatment of neurogenic shock and cardiac arrhythmias; and 4) immediate and adequate treatment of episodes of acute autonomic dysreflexia. In addition to these forms of cardiovascular dysfunction, individuals with acute SCIs are at high risk for deep venous thrombosis (DVT) and pulmonary embolism due to loss of mobility and, potentially, altered fibrinolytic activity, abnormal platelet function, and impaired circadian variations of hemostatic and fibrinolytic parameters. Current evidence supports a recommendation for thromboprophylaxis using mechanical methods and anticoagulants during the acute stage up to 3 months following SCI, depending on the severity and level of injury. Low-molecular-weight heparin is the first choice for anticoagulant prophylaxis in patients with acute SCI. Although there is insufficient evidence to recommend (or refute) the use of screening tests for DVT in asymptomatic adults with acute SCI, this strategy may detect asymptomatic DVT in at least 9.4% of individuals who undergo thromboprophylaxis using lowmolecular- weight heparin. Indications and treatment of DVT and acute pulmonary embolism are well established and are summarized in this review. Recognition of cardiovascular complications after acute SCI is essential to minimize adverse outcomes and to optimize recovery.

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“…On average, trauma patients have a 58% risk of distal DVT and an 18% risk of proximal DVT [2]. If left untreated, half of those who present with a proximal DVT will develop a clinically important PE, and of those, 2%–3% will die as a consequence of the PE [3],[4].…”

Section: Introductionmentioning

confidence: 99%

An Economic Evaluation of Venous Thromboembolism Prophylaxis Strategies in Critically Ill Trauma Patients at Risk of Bleeding

2009

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Do anticoagulants improve survival in patients presenting with venous thromboembolism?

Abstract: Abstract. Kelly J, Hunt BJ (St

Cited by 15 publications

References 111 publications

Anticoagulation or Inferior Vena Cava Filter Placement for Patients With Primary Intracerebral Hemorrhage Developing Venous Thromboembolism?

Anticoagulation or Inferior Vena Cava Filter Placement for Patients With Primary Intracerebral Hemorrhage Developing Venous Thromboembolism?

Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management

An Economic Evaluation of Venous Thromboembolism Prophylaxis Strategies in Critically Ill Trauma Patients at Risk of Bleeding

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