Timing of recurrent venous thromboembolism early after the index event: A meta-analysis of randomized controlled trials

Limone, Brendan; Hernandez, Adrián V.; Michalak, Daniel; Bookhart, Brahim; Coleman, Craig I.

doi:10.1016/j.thromres.2013.08.003

Cited by 48 publications

(25 citation statements)

References 27 publications

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“…Similarly to the meta-analysis of Limone and colleagues, the current study found that patients with an index DVT event had a noticeably higher likelihood of VTE recurrence at Week 1 compared to patients with an index PE event, while the likelihood of recurrence was more similar between these patients in the subsequent weeks 18 . One possible explanation is that PE patients are more carefully treated during the first week due to the severity of the event.…”

Section: Discussionsupporting

confidence: 73%

“…These calculations also followed similar trends for the stratified analyses by gender and type of index VTE (DVT, PE with or without DVT, provoked VTE, unprovoked VTE, and cancer-related), although patients with cancer at baseline had generally a qualitatively higher level of VTE recurrence compared to other patients. A 2013 meta-analysis by Limone and colleagues examined randomized trials of acute pharmacologic treatment and prevention of VTE recurrence to identify the timing of VTE recurrence over the 12 week period following an index VTE event 18 . While the highest rate of VTE recurrence was in Week 1 (0.29 events/person-year, 95% CI ¼ 0.21-0.37), rates remained high through Week 4 (between 0.15 and 0.10 events/person-year) before decreasing and stabilizing in Week 5 (0.05 events/ person-year).…”

Section: Discussionmentioning

confidence: 99%

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Weekly risk of venous thromboembolism recurrence in patients receiving oral anticoagulants

Laliberté

Coleman

Bookhart

et al. 2014

Current Medical Research and Opinion

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Weekly risk of venous thromboembolism recurrence in patients receiving oral anticoagulants

Laliberté

Coleman

Bookhart

et al. 2014

Current Medical Research and Opinion

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“…Although there are no data to provide guidance, we believe an initial period of anticoagulation (at least 7 days if possible) prior to CVAD removal is preferred to prevent thromboembolism and should be considered on a case-by-case basis based on the location and size of the thrombus burden, the risk for embolization and related complications upon CVAD removal, as well as the risk of bleeding with anticoagulation and the potential complications resulting from delayed removal (ie, CVAD-associated sepsis). 65 Guidelines recommend at least 3 months of anticoagulation after CVAD removal. [45][46][47][48][49] …”

Section: Catheter Removalmentioning

confidence: 99%

How I treat central venous access device–related upper extremity deep vein thrombosis

Rajasekhar

Streiff

2017

Blood

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Central venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.

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“…3,19,25) This is important, because residual thrombosis is observed in 50% of patients with PE 1 month after the event, and around 5% of treated patients with PE develop pulmonary hypertension as a result of poor thrombus resolution. 26,27) We present here a summary of the risks posed by incomplete thrombus resolution in VTE, as well as a discussion of treatment approaches and current guidelines, and recent and emerging data on the NOACs in this regard, with a focus on rivaroxaban.…”

Section: Enous Thromboembolism (Vte) Comprising Deepmentioning

confidence: 99%

Overview of Current Evidence on the Impact of the Initial High Dose of the Direct Factor Xa Inhibitor Rivaroxaban on Thrombus Resolution in the Treatment of Venous Thromboembolism

Bauersachs

Koitabashi

2017

Int. Heart J.

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SummaryIncomplete thrombus resolution in patients with venous thromboembolism (VTE) may increase the risk of recurrent thromboembolic events and other complications, such as post-thrombotic syndrome. Various options exist for thrombus resolution, including systemic thrombolytic agents, catheter-directed thrombolysis, and traditional anticoagulants such as heparins or vitamin K antagonists (VKAs). Data are accumulating on the use of non-VKA oral anticoagulants, such as rivaroxaban, and these may provide greater thrombus resolution compared with VKAs. Data from the phase III rivaroxaban studies presented here show that a 21-day intensive dosing regimen of rivaroxaban 15 mg twice daily is effective during the acute treatment phase for VTE, with similar recurrence rates and thrombus resolution to standard anticoagulation. Pooled analyses of phase III studies have also indicated that rivaroxaban 20 mg once daily monotherapy for up to 12 months after this initial intensive treatment period may provide effective prevention of recurrent VTE and a reduction in the risk of major bleeding, irrespective of clot burden. Four case studies from the Darmstadt Academic Teaching Hospital, Germany, and Gunma University Hospital, Japan, are also provided. Further clinical studies and real-world data may improve our understanding of initial intensive dose regimens, and assess the full significance of thrombus burden in VTE. (Int Heart J 2017; 58: 6-15)

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Timing of recurrent venous thromboembolism early after the index event: A meta-analysis of randomized controlled trials

Cited by 48 publications

References 27 publications

Weekly risk of venous thromboembolism recurrence in patients receiving oral anticoagulants

Weekly risk of venous thromboembolism recurrence in patients receiving oral anticoagulants

How I treat central venous access device–related upper extremity deep vein thrombosis

Overview of Current Evidence on the Impact of the Initial High Dose of the Direct Factor Xa Inhibitor Rivaroxaban on Thrombus Resolution in the Treatment of Venous Thromboembolism

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