Prevention and Treatment of Venous Thromboembolism

Nicolaides, Aliki; Fareed, Jawed; Kakkar, AK; Comerota, A. J.; Goldhaber, Samuel Z.; Hull, Russel; Myers, Kenneth A.; Samama, Meyer-Michel; Fletcher, Jacqui; Kalodiki, Evi; Bergqvist, David; Bonnar, J.; Caprini, Joseph A.; Carter, C.; Conard, J; Eklöf, B; Elalamy, I.; Gerotziafas, G.; Geroulakos, George; Giannoukas, A.; Greer, Ian A.; Griffin, M. J.; Kakkos, S.; Lassen, Michael R.; Lowe, G. D. O.; Markel, Arie; Prandoni, Paolo; Raskob, G.; Spyropoulos, Alex C.; Turpie, Alexander G.G.; Walenga, Jeanine M.; Warwick, David

doi:10.1177/1076029612474840

Cited by 118 publications

(86 citation statements)

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“…Anticardiolipin antibody is also now recognized as an important cause of thrombosis [16][17][18]. Screening for these congenital thrombophilic factors as well as anticardiolipin antibody should be performed in patients having sporadic or recurrent thrombosis [19][20][21]. The use of oral contraceptive pill is a common risk factor for venous thromboembolism in women of reproductive age and surgical operations and pregnancy remain important triggers [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Pathogenesismentioning

confidence: 99%

“…The use of oral contraceptive pill is a common risk factor for venous thromboembolism in women of reproductive age and surgical operations and pregnancy remain important triggers [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Prolonged immobility as in long-haul flights and hormonal influences, such as the contraceptive pill, are also well-documented risk factors [9,20,21].…”

Section: Pathogenesismentioning

confidence: 99%

“…In acute DVT patients (21,41,73,74 MECS may also be used for symptomaticrelief of swollen acute DVT legs combined with low-molecular weight heparins (LMWH) followed by vitamin K antogonists (VKA) or novel oral anticoagulants (NOACs). Pneumatic compression therapy has been proved to be effective, but is probably only realistic in post-operative circumstances, and it has shown to be effective in for example elective knee or hip replacement [21,41,74].…”

Section: Management Of Dvt In the Primary Care And Hospital Settingmentioning

confidence: 99%

“…Active exercise and early mobilization is desirable when possible. All hospitalized general medical patients should be assessed for venous thromboembolism risk factors [21]. Those patients classified to be at moderate at high risk should be given thrombosis prophylaxis with LMWH (4000 U or more once daily).…”

Section: Management Of Dvt In the Primary Care And Hospital Settingmentioning

confidence: 99%

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Complete Compression Ultrsonography, Clinical Score, Underlying Risk

Michiels¹,

Strijkers²,

Michiels³

et al. 2015

J Hematol Thrombo Dis

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Primary Superficial Thrombophlebitis (SVT)The incidence of superficial thrombophlebitis (SVT) is approximately 1.6 per 1000 persons per year. Several studies have confirmed the association of SVT and VTE. In a systematic review of patients with SVT, 6% to 44% of cases was associated with deep vein thrombosis (DVT), 20% to 33% with asymptomatic pulmonary embolism (PE) and 2% to 13% with symptomatic PE. Assessment of risk factor in the MEGA study a history of clinical SVT was associated with a 6.3-fold risk of DVT and a 3.9 risk of PE. In a study of 263 SVT patients, 30 (11.4%) developed DVT. Among 125 patients with SVT located in the great saphena vein, 16.8% developed DVT. Out of 138 patients with isolated SVT below the knee only 4.5% developed DVT. In a lower limb ultrasound study in 2646 patients 36 (9.3%) of the patients had combined DVT and PTS. These data indicate that primary SVT should be considered an integral part of DVT. The presence of inherited hypercoagulability or venous thrombophilia in both SVT and DVT strongly supports a similar etiology and pathphysiology. In… patients with primar SVT hereditary protein C and s deficiency was detected in 6.45% in the absence of DVT and in 62.5% in SVT patient who had developed DVT. In our experience hereditary heterozygous antithrombin defiencoiency (AT) is associated with a high risk on DVT and PE not preceded by SVT. Congenital protein C (PC) or protein S (PS) deficiency in 27 DVT patients (15 males, 12 females) in 6 unrelated Dutch families had a history of SVT 19 cases (70%) as the hall mark of congenital PC/PS deficiency. The prevalence of FV Leiden, FII A20210 mutation, and PC or PS deficiency in 63 evaluated SVT patients was 16%, 906% and 10% respectively (total 36%) as compared to 3%, 2.4% and 0.6% in 537 controls. The incidence of inherited thrombophilic risk factors in patients with a first DVT is high (31%) as compared to 5 to 6% in the general population (Table 1). In 1668 patients with a first DVT in the Leiden prospective study the incidence of congenital thrombophilia was 25%. In this study 417 (25%) of 1668 patients with a first DVT were on oral contraceptives below the age of 50 years. In 400 Czech young women with VTE on oral contraceptives (distal DVT 58%, proximal DVT 16%, PE 5%, thrombosis at unusual sites 20%) inherited thrombophilia was diagnosed in 195 (49%): FV Leiden 35% FIIA20210 mutation 5%,AT,PC PS deficiency 3.6% and antiphopholipid syndrome 5.3%. We conclude that thrombophilia screening is manadatory in SVT and DVT patients and in women on contraceptive pills in particular for the education of clinicians abling them to much better counsel their SVT and DVT patients and their relatives. AbstractSuperficial vein thrombosis is an integral part of venous thromboembolism (VTE) together with deep vein thrombosis (DVT) and pulmonary embolism (PE). The incidence of SVT is 1.6 per 1000 persons per year. The incidence of DVT is about 1.0 per 1000 persons per year in the general population, 1.8 per 1000 persons per year at age 65 to 69 years...

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Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Management Of Dvt In the Primary Care And Hospital Settingmentioning

confidence: 99%

Section: Management Of Dvt In the Primary Care And Hospital Settingmentioning

confidence: 99%

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Complete Compression Ultrsonography, Clinical Score, Underlying Risk

Michiels¹,

Strijkers²,

Michiels³

et al. 2015

J Hematol Thrombo Dis

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“…One and five-year VTE recurrence risk is estimated to be 1-5% and 3-15% in patients with provoked VTE and 10% and 30% in those with unprovoked VTE. 1,2 This ongoing risk raises the question as to the appropriate duration of anticoagulant therapy and whether extending treatment beyond the acute period would improve patient outcomes. Extended anticoagulant therapy also comes with risks, primarily that of bleeding that must be weighed against the possible benefits.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of anticoagulants and aspirin for extended treatment of venous thromboembolism: A network meta-analysis

Sobieraj

Coleman

Pasupuleti

et al. 2015

Thrombosis Research

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT Abstract (305 words)Objective: To systematically review the literature and to quantitatively evaluate the efficacy and safety of extended pharmacologic treatment of venous thromboembolism (VTE) through network meta-analysis (NMA).Methods: A systematic literature search (MEDLINE, Embase, Cochrane CENTRAL, throughSeptember 2014) and searching of reference lists of included studies and relevant reviews was conducted to identify randomized controlled trials of patients who completed initial anticoagulant treatment for VTE and then randomized for the extension study; compared extension of anticoagulant treatment to placebo or active control; and reported at least one outcome of interest (VTE or a composite of major bleeding or clinically relevant non-major bleeding). A random-effects Frequentist approach to NMA was used to calculate relative risks with 95% confidence intervals.Results: Ten trials (n=11,079) were included. Risk of bias (assessed with the Cochrane tool) was low in most domains assessed across the included trials. Apixaban (2.5mg and 5mg), dabigatran, rivaroxaban, idraparinux and vitamin K antagonists (VKA) each significantly reduced the risk of VTE recurrence compared to placebo, ranging from a 73% reduction with idraparinux to 86% with VKAs. With exception of idraparinux, all active therapies significantly reduced VTE recurrence risk versus aspirin, ranging from a 73% reduction with either apixaban 2.5mg or rivaroxaban to 80% with VKAs. Apixaban and aspirin were the only therapies that did not increase composite bleeding risk significantly compared to placebo. All active therapies except aspirin increased risk of composite bleeding by 2 to 4-fold compared to apixaban 2.5mg, with no difference found between the two apixaban doses. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTConclusion: Extended treatment of VTE is a reasonable approach to provide continued protection from VTE recurrence although bleeding risk is variable across therapeutic options.Our results indicate that apixaban, dabigatran, rivaroxaban, idraparinux and VKAs all reduced VTE recurrence when compared to placebo. Apixaban appears to have a more favorable safety profile compared to other therapies.

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