Initial and Long-Term Treatment of Deep Vein Thrombosis

2009 ◽  
pp. 473-485
Author(s):  
Gary Raskob
Keyword(s):  
Deep Vein Thrombosis ◽  
Term Treatment ◽  
Vein Thrombosis ◽  
Long Term Treatment ◽  
Deep Vein

Low-molecular-weight heparin in the acute and long-term treatment of deep vein thrombosis

2003 ◽  
Vol 89 (04) ◽  
pp. 674-680 ◽  
Author(s):  
Milena Gebska ◽  
Zbigniew Kadziola ◽  
Neelam Saba ◽  
Pilar Carrasco ◽  
Vijay Kakkar ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Term Treatment ◽  
Low Molecular Weight ◽  
Once Daily ◽  
Vein Thrombosis ◽  
Long Term Treatment ◽  
Group A ◽  
Group B ◽  
Deep Vein

SummaryLow molecular weight heparins (LMWHs) are frequently used during acute treatment of deep vein thrombosis, but their utility for long-term treatment needs to be defined.In this multi-centre trial, 378 patients with acute deep vein thrombosis were randomised to intravenous unfractionated heparin (group A), once daily subcutaneous LMWH (bemiparin) for one week (group B) or once daily bemiparin in a therapeutic dose for one week followed by a maintenance dose for 12 weeks (group C).Fifty-two per cent of patients in group A, 72% of group B and 72% of group C showed venographic reduction in thrombus size assessed objectively on day 14; 20% greater improvement in group B and C indicates not only non-inferiority of bemiparin (p = 0.00003) but also superiority (p = 0.004) compared to UFH. Day 84 venographic or Doppler sonographic recanalisation of the affected veins was demonstrated in 75.3%, 79.8% and 81.5% in groups A, B and C respectively. Mortality, recurrent thromboembolic events and bleeding were similar in the three groups.Both bemiparin regimens were more effective than UFH in reducing thrombus size during the acute phase of treatment. The efficacy in terms of recurrence of venous thromboembolism and safety of Bemiparin is similar to UFH. Bemiparin is also an effective alternative to warfarin for long-term treatment.

Safety and effectiveness of rivaroxaban versus standard anticoagulation for the treatment of symptomatic deep vein thrombosis in routine clinical practice

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 187-193 ◽  
Author(s):  
S. Haas ◽  
R. Kreutz ◽  
M. Gebel ◽  
J. Herold ◽  
J. Schneider ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Practice ◽  
Major Bleeding ◽  
Term Treatment ◽  
Routine Clinical Practice ◽  
Vein Thrombosis ◽  
Long Term Treatment ◽  
All Cause Mortality ◽  
Deep Vein

SummaryIn addition to parenteral anticoagulants and vitamin K antagonists (standard AC), non-vitamin K antagonist oral anticoagulants (NOAC) are increasingly being used for the acute and long-term treatment of deep vein thrombosis (DVT).The international, prospective, non-interventional XALIA study compared the acute and long-term treatment of DVT with rivaroxaban or standard AC under routine clinical practice and confirmed the safety and efficacy of rivaroxaban demonstrated in Phase III studies: annual event rates for major bleeding, VTE and all-cause mortality were 1.2 %, 2.4 % and 0.8 % respectively, compared to 3.4 %, 3.9 %, and 6.2 % with standard AC.The XALIA-DE subgroup analysis examined whether the XALIA results were applicable to Germany. The 586 rivaroxaban patients were younger and fewer had active cancer than the 355 treated with standard AC. As in XALIA, the incidence of major bleeding (1.6 vs. 4.1/100 patient-years [PY]), recurrent VTE (1.9 vs. 4.7/100 PY) and all-cause mortality (1.6 vs. 6.8/100 PY) were lower under rivaroxaban than under standard AC. These rates indicate a favourable benefit-risk profile of rivaroxaban under the conditions of everyday practice.

scholarly journals Long-term recurrence of venous thromboembolism after short-term treatment of symptomatic isolated distal deep vein thrombosis: A cohort study

2017 ◽  
Vol 22 (6) ◽  
pp. 518-524 ◽  
Author(s):  
Marco P Donadini ◽  
Francesco Dentali ◽  
Samuela Pegoraro ◽  
Fulvio Pomero ◽  
Chiara Brignone ◽  
...  
Keyword(s):  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Vein Thrombosis ◽  
Recurrent Vte ◽  
Deep Vein

Isolated distal deep vein thrombosis (IDDVT) is a common clinical manifestation of venous thromboembolism (VTE). However, there are only scant and heterogeneous data available on the long-term risk of recurrent VTE after IDDVT, and the optimal therapeutic management remains uncertain. We carried out a retrospective cohort study of consecutive patients diagnosed with symptomatic IDDVT between 2004 and 2011, according to a predefined short-term treatment protocol (low molecular weight heparin (LMWH) for 4–6 weeks). The primary outcome was the occurrence of recurrent VTE. A total of 321 patients were enrolled. IDDVT was associated with a transient risk factor or cancer in 165 (51.4%) and 56 (17.4%) patients, respectively. LMWH was administered for 4–6 weeks to 280 patients (87.2%), who were included in the primary analysis. Overall, during a mean follow-up of 42.3 months, 42 patients (15%) developed recurrent VTE, which occurred as proximal DVT or PE in 21 cases. The recurrence rate of VTE per 100 patient-years was 3.5 in patients with transient risk factors, 7.2 in patients with unprovoked IDDVT, and 5.9 in patients with cancer ( p=0.018). At multivariable analysis, unprovoked IDDVT and previous VTE were significantly associated with recurrent VTE (HR 2.16, 95% CI 1.12–4.16 and HR 1.97, 95% CI 1.01–3.86, respectively). In conclusion, the long-term risk of recurrent VTE after IDDVT treated for 4–6 weeks is not negligible, in particular in patients with unprovoked IDDVT or cancer. Further studies are needed to clarify whether a longer, but definite treatment duration effectively prevents these recurrences.

Randomized Clinical Trial Of Titrated Dose Subcutaneous Heparin Versus Warfarin In The Long-Term Treatment Of Patients With Venous Thrombosis

1981 ◽  
Vol 46 (01) ◽  
pp. 093-093
Author(s):  
R Hull ◽  
T Delmore ◽  
C Carter ◽  
J Hirsh ◽  
E Genton ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Low Dose ◽  
Term Treatment ◽  
Vein Thrombosis ◽  
Dose Warfarin ◽  
Recurrent Venous Thromboembolism ◽  
Long Term Treatment ◽  
Deep Vein ◽  
Adjusted Dose

We have reported previously that low-dose subcutaneous (sc) heparin is less effective than adjusted dose warfarin sodium in the long-term treatment of venous thrombosis as 9 of 35 patients (26%) receiving low dose sc heparin developed acute recurrent venous thromboembolism compared with none of 33 patients receiving warfarin (p=0.001).Seven patients on warfarin suffered bleeding compared with none on low-dose sc heparin (p < 0.005). Using an identical study design, 101 patients with venographically confirmed acute deep vein thrombosis have entered a second trial reported here, comparing higher doses of sc heparin 12 hourly, titrated at the onset (by adjusting the mid interval PTT to 1½ to 2 times control), compared with adjusted dose warfarin (PT 1½ to 2 times control). All patients were treated with full doses of heparin for 14 days and then randomized to either treatment group for a 12 week course. The patients were followed in a special clinic and routinely screened with leg scanning and impedance plethysmography at 3 week intervals and on an emergency basis if they developed recurrent symptoms.During long-term treatment no patient on warfarin or titrated sc heparin developed recurrent venous thromboembolism. On follow-up, after discontinuation of long-term therapy, 4 patients randomized to warfarin and 4 patients randomized to titrated sc heparin developed recurrent deep vein thrombosis confirmed by objective testing. One of 51 patients on titrated sc heparin suffered bleeding compared with 9 of 50 patients on warfarin (p < 0.02).These results suggest that titrated sc heparin is as effective as warfarin for preventing recurrent venous thromboembolism and its use is associated with less bleeding than warfarin.

Long-term treatment of deep-vein thrombosis with low-molecular-weight heparin: An update of the evidence

2013 ◽  
Vol 110 (07) ◽  
pp. 14-22 ◽  
Author(s):  
Grace Townshend ◽  
Russell Hull
Keyword(s):  
Low Molecular Weight Heparin ◽  
Term Treatment ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Evidence Based ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Long Term Treatment ◽  
Deep Vein

SummaryThis article reviews updated evidence-based knowledge on long-term treatment of deep-vein thrombosis (DVT) with low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs). Eleven trials were identified comparing the two treatments in a broad spectrum of patients with DVT and with >100 study participants. Four comparative trials were identified in patients with cancer and DVT (in whom anticoagulation treatment is more complex and bleeding complications more frequent). In the 11 trials in broad patient populations, LMWHs were as effective as VKAs in preventing recurrent venous thromboembolism (VTE), and there were no consistent differences in the incidence of bleeding complications during long-term treatment. In patients with cancer, VTE recurrence was significantly reduced with LMWH versus VKA in two studies, while major bleeding complications did not differ between groups in any of the four trials. Current evidence-based European and American guidelines recommend LMWH over VKA for the long-term treatment of DVT in patients with cancer. LMWH and VKA are recommended over the new oral anticoagulant drugs, for which there are limited data on use in long-term treatment. Post-thrombotic syndrome (PTS), a common complication of DVT, causes considerable morbidity. Long-term use of tinzaparin reduced the risk of PTS compared with VKA in one trial, and a meta-analysis of nine studies in total demonstrated a consistently favourable effect of LMWHs versus VKA on PTS-related outcomes. Given the limited treatment options available for PTS, this suggests that LMWHs provide a useful therapeutic option in any patient particularly at risk of developing PTS.

Sign in / Sign up

Export Citation Format

Share Document