Long-term treatment of venous thromboembolism with tinzaparin compared to vitamin K antagonists: A meta-analysis of 5 randomized trials in non-cancer and cancer patients

2012 ◽  
Vol 130 (6) ◽  
pp. 853-858 ◽  
Author(s):  
Silvy Laporte ◽  
Laurent Bertoletti ◽  
Antonio Romera ◽  
Patrick Mismetti ◽  
Luis A. Pérez de Llano ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Vitamin K ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Term Treatment ◽  
Long Term Treatment

Vitamin K antagonists

2012 ◽  
Vol 32 (04) ◽  
pp. 249-257 ◽  
Author(s):  
T. F. Luscher ◽  
J. Steffel
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Drug Interactions ◽  
Vitamin K ◽  
Stroke Prevention ◽  
Vitamin K Antagonists ◽  
Term Treatment ◽  
Thrombin Inhibitor ◽  
Long Term Treatment

SummaryFor the last decades, anticoagulation for stroke prevention in atrial fibrillation (AF) as well as for the prophylaxis and long-term treatment of venous thromboembolism has been entirely based on vitamin K antagonists (VKA). Although very effective under optimal conditions, long-term treatment with these drugs is flawed by the fact that the time in the therapeutic range frequently is suboptimal due to biological factors, drug interactions and compliance.The direct thrombin inhibitor dabigatran, as well as the direct FXa inhibitors rivaroxaban and apixaban provide more consistent anticoagulation and have proven their efficacy and safety against VKAs in several large scale randomized clinical trials for stroke prevention in atrial fibrillation as well as for the treatment and prevention of venous thromboembolism. In view of these convincing data and other advantages such as the lack of mandatory monitoring and only few drug interactions,VKAs will most likely be replaced in a majority of patients for these indications. Based on the most recent trial evidence, the current review discusses the role of VKA treatmentand that of the novel anticoagulants.

Idiopathic venous thrombosis

2006 ◽  
Vol 26 (01) ◽  
pp. 48-51 ◽  
Author(s):  
S. Haas
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Term Treatment ◽  
Bleeding Complications ◽  
Individual Risk ◽  
Long Term Treatment ◽  
Net Clinical Benefit ◽  
The Individual

SummaryIdiopathic venous thromboembolism has been shown to be associated with a high frequency of recurrence. Therefore, the most important aim of long-term treatment is secondary prevention. It has also been shown that long-term anticoagulation with vitamin K antagonists can impressively reduce the rate of recurrence. However, this effect was only maintained during anticoagulation and disappeared after cessation of anticoagulant therapy. Unfortunately, the individual risk of recurrence is not predictable. Therefore, longterm anticoagulation appears beneficial across all subgroups of patients suffering from venous thromboembolism, regardless of the presence of thrombophilia or other burden of the disease. Despite the increasing body of evidence regarding the advantages of long-term anticoagulation, bleeding complications may limit the net clinical benefit of this strategy. Thus, the development of anticoagulants having a low potential for adverse reactions and providing similar beneficial antithrombotic effects to vitamin K antagonists will enhance the readiness for their wide spread use and life long administration.

scholarly journals The international normalized ratio (INR) as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

2015 ◽  
Vol 28 (4) ◽  
pp. 269-272
Author(s):  
Anna Szczepańska-Szerej ◽  
Magdalena Wojtan ◽  
Beata Szajnoga
Keyword(s):  
Atrial Fibrillation ◽  
Cerebral Infarction ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
Blood Parameters ◽  
Term Treatment ◽  
Adequate Treatment ◽  
Long Term Treatment

Abstract It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF). While oral anticoagulation with vitamin K antagonists (AVKs) substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR) in order to achieve therapeutic levels (2,0-3,0). The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2) were seen in thirty-five of these individuals (38,8%), while 55 (61,2%) showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p<0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.

A worldwide survey to assess the current approach to the treatment of patients with cancer and venous thromboembolism

2013 ◽  
Vol 110 (11) ◽  
pp. 959-965 ◽  
Author(s):  
Anita Aggarwal ◽  
Annemarie van de Geer ◽  
Charles Faselis ◽  
Harry R. Büller ◽  
Marcello Di Nisio ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K Antagonists ◽  
Term Treatment ◽  
Current Approach ◽  
Survey Tool ◽  
General Internal ◽  
Patients With Cancer ◽  
First Choice ◽  
Long Term Treatment

SummaryLow-molecular-weight heparin (LWMH) is recommended as the preferred anticoagulant treatment over vitamin K antagonists (VKA) for venous thromboembolism (VTE) in patients with cancer. However, there is uncertainty about the duration and dose of LMWH treatment. Therefore, we designed this multinational survey to assess the current approach to the treatment of patients with cancer and VTE. An electronic survey tool was used to disseminate a survey containing 49 questions on different aspects of the treatment of patients with cancer and VTE, among both thrombosis and non-thrombosis specialists. A total of 229 invitations were sent, and 141 completed the survey (60% of the total). Fifty-eight percent of the respondents were from Europe, 35% from the US and the remaining 7% from other countries. Respondent’s specialties included haematology (23%), oncology (18%), pulmonology (15%) and general internal medicine (15%). LMWH was indicated as the first choice for the long-term treatment by 82% of the respondents, of whom 60% used full therapeutic doses and 40% chose a dose reduction. When continuing anticoagulants after the long-term treatment period, 44% of respondents preferred LMWH, 10% VKA, while the remaining 45% chose per individual patient for either LMWH or VKA. In conclusion, we observed a relatively high observance rate of the guidelines with respect to the use of LMWH for the long-term treatment of VTE in cancer. In contrast, the dose of LMWH and the type of anticoagulant chosen after the initial 3–12 months varied substantially, probably reflecting the limited available evidence.

Efficacy of Thyroid Hormone Suppression for Benign Thyroid Nodules: Meta-Analysis of Randomized Trials

2005 ◽  
Vol 133 (3) ◽  
pp. 391-396 ◽  
Author(s):  
Matthew T. Sdano ◽  
Mercedes Falciglia ◽  
Jeffrey A. Welge ◽  
David L. Steward
Keyword(s):  
Thyroid Nodule ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Term Treatment ◽  
Volume Reduction ◽  
Benign Thyroid Nodule ◽  
Long Term Treatment ◽  
Nodule Volume ◽  
Benign Thyroid

OBJECTIVE: To determine the efficacy of thyroid hormone suppressive therapy (THST) to decrease benign thyroid nodule volume. DESIGN: Meta-analysis. METHODS: Systematic search using electronic databases (PubMed, Medline, Cochrane Library) through August 2004, paper review, and contacting experts and drug manufacturers. Only randomized controlled studies of THST vs no treatment or placebo, for reduction of benign thyroid nodule volume, were included. Exclusion criteria were: >6-month treatment, lack of ultrasound volume measurement, and region of endemic goiter. Primary outcome was clinically relevant nodule volume reduction (>50%), with a random effects model (RevMan4.2). RESULTS: Nine randomized trials were included (609 subjects). Subjects were 88% more likely to experience >50% nodule volume reduction with THST than placebo or no treatment (relative risk = 1.88; 95% CI = 1.18-3.01; P = 0.008). However, 8 subjects must be subjected to the risk of cardiac and skeletal side effects from THST, for one to benefit from therapy (number needed to treat = 8, risk difference = 0.13; 95% CI = 0.06-0.19; P = 0.0003). Sensitivity analysis reveals that 15 null studies would have to have been missed to reverse statistical significance (fail-safe N = 15). Review of the only study with long-term treatment (5 years) suggests no significant difference in nodule volume reduction between THST and placebo. Further, studies with follow-up after THST withdrawal demonstrate rapid increase in thyroid nodule and goiter volumes. CONCLUSION: THST appears more likely than placebo or no treatment to significantly reduce benign thyroid nodule volume, but long-term treatment may be less effective and regrowth is likely following cessation of therapy. Given the risks of THST, routine use is not recommended for benign nodules.

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