Quality of oral anticoagulant treatment and risk of subsequent recurrent thromboembolism in patients with deep vein thrombosis

Current guidelines recommend to prolong anticoagulant treatment in patients with cancer with venous thromboembolism (VTE); only few studies evaluated other parameters than cancer itself for selecting patients at higher risk of recurrent VTE. Long-term management of VTE is thus challenged by several controversies mainly for patients compliance. We here report results of a long-term follow-up in patients with deep vein thrombosis under anticoagulant treatment with low-molecular-weight heparin (LMWH) for residual vein thrombosis (RVT) detected at compression ultrasonography (CUS), 6 months after standard anticoagulant treatment. Patients with RVT were deemed at high risk of recurrences and included in the current observational study. They continued LMWH (reduced at 75% standard dose) for further additional 2 years after enrolment or until death. Patients were followed up every 3 months or earlier, if needed. Among ancillary study end points, there was the assessment of patients’ quality of life during daily treatment with subcutaneous injections. Quality of life was determined by the EORTC-C30 questionnaire, administered by a skilled psychologist at enrolment and every 6 months follow-up visits. Overall, 128 patients were evaluated during follow-up. Mean global EORTC-C30 score at enrollment and at 6, 12 and 24 months follow-up were 52.1, 51.4, 50.8 and 50.1, respectively. There were no statistically significant differences between scores at enrolment and at the last available follow-up (P = .1). Long-term treatment with LMWH resulted, effective and safe, it was globally well tolerated and exempt of negative impact on quality of life of the enrolled patients. Reported results support long-term anticoagulant treatment with LMWH in cancer patients at risk of recurrent VTE.

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Controlled Trial of the Sequential Use of Streptokinase and Ancrod in the Treatment of Deep Vein Thrombosis of Lower Limb

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649223 ◽

1977 ◽

Vol 37 (02) ◽

pp. 222-232 ◽

Cited By ~ 12

Author(s):

D. A Tibbutt ◽

C. N Chesterman ◽

E. W Williams ◽

T Faulkner ◽

A. A Sharp

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Improvement ◽

Anticoagulant Therapy ◽

Lower Limb ◽

Oral Anticoagulant ◽

Controlled Trial ◽

Oral Anticoagulant Therapy ◽

Control Group ◽

Vein Thrombosis ◽

Deep Vein

SummaryTreatment with streptokinase (‘Kabikinase’) was given to 26 patients with venographically confirmed deep vein thrombosis extending into the popliteal vein or above. Treatment was continued for 4 days and the patients were allocated randomly to oral anticoagulant therapy or a course of treatment with ancrod (‘Arvin’) for 6 days followed by oral anticoagulant therapy. The degree of thrombolysis as judged by further venographic examination at 10 days was not significantly different between the 2 groups. The majority of patients showed clinical improvement but there was no appreciable difference between the groups at 3 and 6 months. Haemorrhagic complications were a more serious problem during the period of treatment with ancrod than during the equivalent period in the control group.

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Catheter-directed thrombolysis for deep vein thrombosis: 2021 update

Vascular Medicine ◽

10.1177/1358863x211042930 ◽

2021 ◽

pp. 1358863X2110429

Author(s):

Samuel Z Goldhaber ◽

Elizabeth A Magnuson ◽

Khaja M Chinnakondepalli ◽

David J Cohen ◽

Suresh Vedantham

Keyword(s):

Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Related Quality ◽

Health Related ◽

Deep Vein ◽

Major Reduction ◽

Selection Of Patients ◽

Selection Of

Catheter-directed thrombolysis (CDT) has been utilized as an adjunct to anticoagulant therapy in selected patients with deep vein thrombosis (DVT) for approximately 30 years. CDT used to be limited to patients with DVT causing acute limb threat and those exhibiting failure of initial anticoagulation, but has expanded over time. Randomized trials evaluating the first-line use of CDT for proximal DVT have demonstrated that CDT does not produce a major reduction in the occurrence of post-thrombotic syndrome (PTS) and that it is poorly suited for elderly patients and those with limited thrombus extent or major risk factors for bleeding. However, CDT does offer selected patients with acute iliofemoral DVT improvement in reducing early DVT symptoms, in achieving reduction in PTS severity, and in producing an improvement in health-related quality of life (QOL). Clinical practice guidelines from medical and surgical societies are now largely aligned with the randomized trial results. This review offers the reader an update on the results of recently completed clinical trials, and additional guidance on appropriate selection of patients with DVT for catheter-directed thrombolytic therapy.

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Comparison of 3 and 6 Months of Oral Anticoagulant Therapy After a First Episode of Proximal Deep Vein Thrombosis or Pulmonary Embolism and Comparison of 6 and 12 Weeks of Therapy After Isolated Calf Deep Vein Thrombosis

Circulation ◽

10.1161/01.cir.103.20.2453 ◽

2001 ◽

Vol 103 (20) ◽

pp. 2453-2460 ◽

Cited By ~ 255

Author(s):

Laurent Pinede ◽

Jacques Ninet ◽

Pierre Duhaut ◽

Sylvie Chabaud ◽

Sylvie Demolombe-Rague ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Proximal Deep Vein Thrombosis ◽

First Episode ◽

Vein Thrombosis ◽

Deep Vein

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Comparison of Pharmacomechanical Catheter-Directed Thrombolysis versus Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis: Measures of Long-Term Clinical Outcome and Quality of Life

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.10.004 ◽

2022 ◽

Vol 10 (1) ◽

pp. 283

Author(s):

T. Huang ◽

W. Ding ◽

Z. Chen ◽

Y. Yin ◽

J. Yu ◽

...

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Clinical Outcome ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

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Consistency of safety monitoring using routine national databases: results using a quality of care interpretative model

European Journal of Public Health ◽

10.1093/eurpub/ckaa071 ◽

2020 ◽

Vol 30 (6) ◽

pp. 1041-1048

Author(s):

Barbara Labella ◽

Patrizia Giannantoni ◽

Roberta De Blasi ◽

Giovanni Caracci ◽

Fabrizio Carinci

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Quality Of Care ◽

Safety Monitoring ◽

Vein Thrombosis ◽

Increased Risk ◽

National Databases ◽

Deep Vein ◽

Interpretative Model

Abstract Background In the framework of targeted action for continuous safety monitoring, we aimed to evaluate the consistency of indicators derived from available databases for regular reporting. Methods We used a quality of care interpretative model to select characteristics from five national databases, aggregated and linked by homogeneous groups of providers. The target population included all subjects admitted to public hospitals for acute care in four regions of Italy between 2011 and 2013. The association between structures, processes and safety-related outcomes was investigated using odds ratios from generalized estimating equations logistic regression. Outcome measures included claims of malpractice and five patient safety indicators calculated from discharge abstracts using standardized algorithms. Results Over 3 years, claims of malpractice and sepsis increased, whereas deep vein thrombosis and pulmonary embolism decreased. Hospitals with high vs. low volume of discharges were associated with −16% lower rates of claims, but +12% increased risk of sepsis. Compared with research institutes, university clinics had −17% lower rates of claims and −41% cases of dehiscence, with a +32% increased risk of deep vein thrombosis. Local health care authorities recorded −49% deep vein thrombosis, −26% pulmonary embolism, −40% sepsis and +37% risk of claims. Hospitals submitting cases of safe practices and implementing safety recommendations showed significantly higher rates for most outcome measures. Conclusions Indicators from regular databases can be conveniently used to develop a national safety monitoring system for hospital care. Although deeper analysis is needed, institutions with a higher propensity to implement safe practices and recommendations consistently showed higher rates of adverse events.

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More than one in two venous thromboembolism treated in French hospitals occurs during the hospital stays

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515575592 ◽

2015 ◽

Vol 31 (6) ◽

pp. 390-396 ◽

Cited By ~ 2

Author(s):

Francois-André Allaert ◽

Eric Benzenine ◽

Catherine Quantin

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Hospital Stay ◽

Principal Diagnosis ◽

Vein Thrombosis ◽

Icd 10 ◽

Hospital Stays ◽

Deep Vein

Objective The objective was to describe the prevalence of venous thromboembolism, pulmonary embolism, and deep vein thrombosis among hospitalized patients and the percentages of those occurring during the hospital stays. Methods French DRG gave now the opportunity to investigate the frequency of venous thromboembolism occurring during the hospital stay. Statistics are issued from the national PMSI MCO databases encoded using the CIM10. Since 2010–2011 it is possible to differentiate the reason for hospital admission from the pathologies which secondly occurred. Any stay with the ICD-10 codes selected was considered as a hospital-occurred thrombosis unless it was the principal diagnosis of the first medical unit summary. To eliminate outpatient consultations or in day care, stays of <48 h were excluded. Results The results pertain to the 78,838,983 hospitalizations in France from 2005 to 2011 and on the 18,683,603 hospital stays in 2010–2011. The incidence of hospital stays came to 860,343 (1.09%) for venous thromboembolism, with 428,261 (0.543%) for deep vein thrombosis without pulmonary embolism and 432,082 (0.548%) for pulmonary embolism. It corresponds to an incidence of 189 per 100,000 inhabitants. Out of 100 hospital stays involving venous thromboembolism, for 40.3% venous thromboembolism was the cause of hospitalization whereas 59.7% can be considered to have occurred during hospital stay. These distributions are of 25.6 and 74.4% for deep vein thrombosis, respectively, 53.8 and 46.2% for pulmonary embolism. Conclusion The high proportion of hospital-occurred venous thromboembolism is an alarming situation that should question the quality of prevention and/or its effectiveness.

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