scholarly journals Variability in the management of line-related upper extremity deep vein thrombosis

2019 ◽  
Vol 34 (8) ◽  
pp. 552-558 ◽  
Author(s):  
Rafael Cires-Drouet ◽  
Jashank Sharma ◽  
Tara McDonald ◽  
John D Sorkin ◽  
Brajesh K Lal
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Exact Test ◽  
Medical Specialists ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Question Survey

Objectives Central-venous devices are risk-factors for upper extremity deep vein thrombosis. We surveyed physicians to identify practice-patterns and adherence to American College of Chest Physicians guidelines. Methods The 13-question survey obtained physician-demographics and treatment-choices. Respondents were grouped into surgical and medical specialists. Data were reported as ratios and percentages, and compared using Fisher’s exact test. Results We received 143 responses from physicians; 65% treated one-to-two new cases/month. Most physicians (69.2%) used anticoagulation; 36.4% retained the catheter and 32.9% removed it. Medical-specialists retained catheters more often than surgeons ( p = 0.027). For recurrences, 84% repeated anticoagulation; 50.3% retained the catheter. A majority anticoagulated upper-extremity deep-vein thrombosis in long-term catheters for three months only (55.1%). Direct oral anticoagulants were used frequently (43.6%). Only 10% believed that existing guidelines were appropriate and only 2.8% followed all guidelines. Conclusion There is great variability in treatment-decisions for upper-extremity deep-vein thrombosis. The existing guidelines are considered inadequate and not followed by most physicians.

scholarly journals Treatment with direct oral anticoagulants in patients with upper extremity deep vein thrombosis

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Francisco Sánchez Montiel ◽  
Raein Ghazvinian ◽  
Anders Gottsäter ◽  
Johan Elf
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vein Thrombosis ◽  
Deep Vein

Upper extremity deep vein thrombosis treated with direct oral anticoagulants: a multi-center real world experience

2020 ◽  
Vol 50 (2) ◽  
pp. 355-360 ◽  
Author(s):  
Angelo Porfidia ◽  
Fabiana Agostini ◽  
Igor Giarretta ◽  
Diego Tonello ◽  
Daniele Pastori ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Upper Extremity ◽  
Real World ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals ORAL ANTICOAGULANTS IN THE TREATMENT OF VENOUS THROMBOEMBOLIC COMPLICATIONS: FOCUS ON APIXABAN

2017 ◽  
pp. 56-62 ◽  
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Vitamin K Antagonist ◽  
Fixed Dose ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Deep Vein

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

Analysis of therapy effectiveness of deep vein thrombosis of lower limbs with warfarin and rivaroxaban in the long-term period

2020 ◽  
Author(s):  
А.А. Полянцев ◽  
Д.В. Фролов ◽  
Д.В. Линченко ◽  
Ю.В. Щелокова ◽  
Т.А. Литвинова ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Lower Limbs ◽  
Prophylactic Regimen ◽  
Therapy Regimen ◽  
Vein Thrombosis ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Введение. Влияние стандартной и альтернативных схем антикоагулянтной терапии на степень и скорость реканализации глубоких вен привлекает внимание современных исследователей. Цель исследования: сравнение эффективности терапии тромбоза глубоких вен (ТГВ) нижних конечностей варфарином и ривароксабаном в отдаленном периоде. Материалы и методы. В исследование включено 94 пациента с ТГВ нижних конечностей, которые были разделены на 2 группы в зависимости от назначенной схемы лечения. Средний возраст 50 пациентов группы 1 составил 44,0 12,6 лет, 44 больных группы 2 39,5 11,7 лет. Пациентам группы 1 был назначен варфарин, группы 2 ривароксабан в течение 6 мес после выписки. Конечная точка наблюдения 4 года. Результаты. Прием антикоагулянта ранее установленного срока прекратили 18 (36) пациентов из группы 1 и 2 (4,5) пациента из группы 2. Режим эластической компрессии в обеих группах пациенты соблюдали нерегулярно. Рецидив венозных тромбоэмболических осложнений в группе 1 отмечен в 11 (22) случаях, в группе 2 у 7 (15,9) пациентов. Отрицательная динамика ультразвукового обследования складывалась у пациентов обеих групп: у 16 пациентов группы 1 и у 9,1 группы 2 появились признаки поражения ранее неизмененных вен или окклюзия ранее проходимой вены после перенесенного тромбоза без клиники острого венозного тромбоза в анамнезе. Трофические расстройства отмечены у одного пациента группы 2 и у 1/3 пациентов группы 1 к четвертому году наблюдения. Значимые отличия между группами были получены по таким параметрам, как приверженность к лечению и степень тяжести венозной недостаточности, оцениваемая клинически, в пользу ривароксабана. Заключение. Неудовлетворительные результаты лечения при использовании стандартной схемы терапии ТГВ требуют назначения препаратов из группы новых оральных антикоагулянтов с возможным внедрением схемы профилактического приема. Introduction. Effect of standard and alternative anticoagulant therapy regimens on the degree and rapidity of deep vein recanalization attracts the attention of modern researchers. Aim: to compare the treatment effectiveness of deep vein thrombosis (DVT) of lower limbs with warfarin and rivaroxaban in the long-term period. Materials and methods. The study included 94 patients with DVT of lower limbs they were divided into 2 groups depending on the prescribed treatment regimen. The average age of 50 patients of group 1 was 44.0 12.6 years, 44 patients of group 2 39.5 11.7 years. Warfarin was prescribed to patients of group 1, rivaroxaban to patients of group 2 treatment was prescribed for 6 months after discharge. The endpoint of observation was 4 years. Results. 18 (36) patients from group 1 and 2 (4.5) patients from group 2 stopped taking the anticoagulant earlier than target date. Elastic compression treatment patients in both groups kept irregularly. Recurrence of venous thromboembolic complications in group 1 was noted in 11 (22) cases, in group 2 in 7 (15.9) patients. The negative ultrasound dynamics was observed in patients of both groups: 16 of patients in group 1 and 9.1 in group 2 had lesion signs of previously unchanged veins or occlusion of a previously passable vein after thrombosis without clinic of acute venous thrombosis. Trophic disorders were identified in 1 patient in group 2 and in 1/3 of patients in group 1 by the 4th year of observation. Significant differences between the groups were obtained in favor of rivaroxaban according to such parameters as adherence to treatment and the severity of venous insufficiency. Conclusion. Unsatisfactory results of DVT treatment with standard therapy regimen require the administration of new oral anticoagulants with the possible introduction of prophylactic regimen.

Upper extremities deep vein thrombosis and DOAC treatment: a prospective cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.C Vedovati ◽  
G Tratar ◽  
A Mavri ◽  
L Pierpaoli ◽  
G Agnelli ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Pacemaker Implantation ◽  
Limb Ischemia ◽  
Central Venous Line ◽  
Upper Extremities ◽  
Acute Limb Ischemia ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited. Purpose To assess the effectiveness and safety of DOACs in the treatment of UEDVT. Methods Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts of patients with venous thromboembolism (VTE). Study outcomes were recurrent VTE and major bleeding (MB) occurring during DOAC treatment. Results Overall, 132 patients were included: mean age was 47.7±18.0 years (range 18 to 97), males were 42.4%. Twenty-seven percent of patients had 2 or more risk factors for VTE, 29.5% had UEDVT complicating a central venous line or after pacemaker implantation (Table). Ninety-two patients (70%) were managed as outpatients. Increased age (OR 1.03, 95% CI 1.0–1.05) and anemia (OR 1.35, 95% CI 1.07–1.70) were associated with in-patient management. Among patients treated with apixaban (40) or rivaroxaban (85) loading dose was used in 72%; in patients treated with dabigatran (5) or edoxaban (2) mean heparin pre-treatment was 8 days. DOACs were started after 1 month from UEDVT diagnosis in 12.9% of patients; active cancer was a main predictor for delayed initiation (OR 22.2, 95% CI 5.8–84.4). Mean treatment duration in patients with a scheduled stop was 4.9 months, while mean followup in those who continued DOACs was 9.3 months. No recurrence of VTE nor MBs occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-MBs (3 genital, 2 epistaxis, 1 gingival, 1 genital bleeding plus epistaxis; 10.51% patient-year), 5 deaths (4 cancer, 1 advanced age; 9.69% patient-year). Conclusions Our data support the effectiveness and safety of DOACs for the treatment of acute UEDVT. Further studies are required to confirm these findings. Funding Acknowledgement Type of funding source: None

Morbidly Obese Patient on Rivaroxaban Presents With Recurrent Upper Extremity Deep Vein Thrombosis: A Case Report

2019 ◽  
Vol 33 (5) ◽  
pp. 712-719 ◽  
Author(s):  
Sin-Ling T. Jennings ◽  
Khanh N. P. Manh ◽  
Jusilda Bita
Keyword(s):  
Deep Vein Thrombosis ◽  
Obese Patient ◽  
Upper Extremity ◽  
Oral Anticoagulants ◽  
Morbidly Obese ◽  
Vein Thrombosis ◽  
Morbidly Obese Patient ◽  
The Right ◽  
Direct Acting ◽  
Deep Vein

A morbidly obese patient with history of deep vein thrombosis and pulmonary embolism was diagnosed with an acute left upper extremity deep vein thrombosis and started on rivaroxaban. Three months later, the patient returned with swelling in the right arm and was found to have a right brachial thrombosis. Anticoagulant therapy was switched to a low-molecular-weight heparin, and patient was discharged on enoxaparin along with an order to follow-up with a hematologist. Subanalyses from randomized controlled trials, pharmacokinetic/pharmacodynamic, and real-world studies suggest that rivaroxaban may be effective and safe in morbidly obese patients for primary and secondary prevention of venous thromboembolism. However, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis does not recommend the use of direct-acting oral anticoagulants in this population. If used, drug levels should be monitored to guide the therapy. Due to the disparity in data to show efficacy and safety of rivaroxaban in morbidly obese subjects, the interpatient variability of rivaroxaban’s effects in subjects, and the lack of defined therapeutic range for rivaroxaban drug concentration, rivaroxaban should be used cautiously in this population.

scholarly journals Association between Sarcopenia/Lower Muscle Mass and Short-Term Regression of Deep Vein Thrombosis Using Direct Oral Anticoagulants

2020 ◽  
Vol 61 (4) ◽  
pp. 787-794
Author(s):  
Yuta Torii ◽  
Kenya Kusunose ◽  
Robert Zheng ◽  
Hirotsugu Yamada ◽  
Rie Amano ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Muscle Mass ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Short Term ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals Treatment Failure of Venous Stenting With or Without Direct Oral Anticoagulants (DOAC) / Non-Vitamin K Oral Anticoagulants (NOACs) in Patients With Deep Vein Thrombosis (DVT) in Term of the Stent Patency: Protocol for a Systematic Review

2021 ◽  
Author(s):  
Bahram Mohebbi ◽  
Jamal Moosavi ◽  
Behshid Ghadrdoost ◽  
Ayatollah Bayatian ◽  
Hooman Bakhshandeh ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Treatment Failure ◽  
Vitamin K ◽  
Patency Rate ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Stent Patency ◽  
Venous Stenting ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Venous stenting plays a significant role in the treatment of acute deep vein thrombosis (DVT). But the adjuvant anti-coagulant therapy could also help to more successful patency rate. We hope to elucidate the differences in the patency rate of venous stenting with or without direct oral anticoagulants (DOAC) / non-vitamin K oral anticoagulants (NOACs). Methods: Studies that work on the stent patency rate in venous stent with or without DOAC / NOAC will be included. The primary studies (Cohort, case control, case-series or randomized/ non-randomized trials) will be included if the participants / patients have had acute or chronic DVT, with venous stenting (at least one study group or all of study subjects) who have received DOAC / NOAC agents. The stent patency rate should be reported in all of study subjects within a follow-up time, minimum for 1 year. We will perform an electronic search on published or in press articles, which have been published in MEDLINE / PubMed, Embase, the online Cochrane database, CENTRAL and searches of clinical trial registries: clinicalTrials.gov, EU Clinical Trials, ISRCTN registry, WHO network registry for trials. PROSPERO databases will be manually searched for protocols.After screening of the relevant articles, selection and data extraction will be conducted in duplicate and independently. Methodological quality of the selected studies will be assessed using the Newcastle Ottawa Scale (NOS) tool. We will use “Hazard Ratio” (HR) as the optimum Effect Size (ES) in this meta-analysis, otherwise we will use or calculate “Risk Ratio” (RR) or “Odds Ratio” (OR) ES measures as the selected study specific ES. Discussion: In this review, we hope to find the treatment failure/ success rate of venous stenting with or without DOAC / NOAC regards to the stent patency rate and will try to provide insights into the right choice of anti-coagulant therapy.Submitted to PROSPERO (20/9/2021): CRD42021274542

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