Extended Therapy for Primary and Secondary Prevention of Venous Thromboembolism

2010 ◽  
Vol 23 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Susan E. Conway ◽  
Todd R. Marcy
Keyword(s):  
Health Care ◽  
Venous Thromboembolism ◽  
Secondary Prevention ◽  
Practice Guidelines ◽  
Anticoagulation Therapy ◽  
Patient Specific ◽  
First Episode ◽  
Care Providers ◽  
Primary And Secondary Prevention ◽  
Optimal Duration

Clinical practice guidelines currently suggest extended anticoagulation therapy for primary and secondary prevention of venous thromboembolism (VTE). The optimal duration of anticoagulation has been an active area of clinical investigation for patients undergoing orthopedic surgeries and those diagnosed with a first episode of unprovoked VTE. Practice guidelines, VTE incidence, clinical predictors/mediators, and clinical trial evidence is reviewed to help pharmacists and other health care providers make an informed, patient-specific decision on the optimal duration of anticoagulation therapy. Extended anticoagulation up to 5 weeks following orthopedic surgery for primary VTE prevention and indefinitely following a first episode of unprovoked VTE for secondary VTE prevention should be considered only if the risk of bleeding is not high and the cost and burden of anticoagulation is acceptable to the patient. The optimal duration of anticoagulation therapy for primary or secondary prevention of VTE should include the health care provider and patient making a decision based on evaluation of individual benefits, risks, and preferences.

Primary and Secondary Prevention of CAD: A Review

2021 ◽  
Author(s):  
Lindsay Short ◽  
Van T. La ◽  
Mandira Patel ◽  
Ramdas G. Pai
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Health Care Providers ◽  
Clear Understanding ◽  
Care Providers ◽  
Primary And Secondary Prevention ◽  
Cardiac Events ◽  
Management Options ◽  
Artery Disease

AbstractCoronary artery disease is the leading cause of death in both men and women, yet adequate control of risk factors can largely reduce the incidence and recurrence of cardiac events. In this review, we discuss various life style and pharmacological measures for both the primary and secondary prevention of coronary artery disease. With a clear understanding of management options, health care providers have an excellent opportunity to educate patients and ameliorate a significant burden of morbidity and mortality.

Development and Evaluation of a Web-Based Training Program for Oral Health Care Providers on Secondary Prevention of Eating Disorders

2009 ◽  
Vol 73 (6) ◽  
pp. 718-729 ◽  
Author(s):  
Rita D. DeBate ◽  
Herbert Severson ◽  
Marissa L. Zwald ◽  
Tracy Shaw ◽  
Steve Christiansen ◽  
...  
Keyword(s):  
Health Care ◽  
Eating Disorders ◽  
Oral Health ◽  
Secondary Prevention ◽  
Training Program ◽  
Health Care Providers ◽  
Oral Health Care ◽  
Care Providers ◽  
Web Based

Extended therapy and secondary prevention of venous thromboembolic complications

2020 ◽  
Vol 28 (4) ◽  
pp. 548-566
Author(s):  
Alexei Petrikov ◽  
I. I. Prostov
Keyword(s):  
Secondary Prevention ◽  
Venous Thrombosis ◽  
Anticoagulation Therapy ◽  
Individual Risk ◽  
First Episode ◽  
Limiting Factor ◽  
Thromboembolic Complications ◽  
Prolonged Therapy ◽  
Venous Thromboembolic ◽  
Evidential Basis

Venous thromboembolic complications (VTEC) are acute and time-limited diseases. However, the recurrence rate after a first episode of VTEC is high and potentially life-threatening. Developed deep vein thrombosis (DVT) and thromboembolism of pulmonary artery (TEPA) are inevitably associated with use of anticoagulant therapy (ACT). A peculiarity of the modern clinical management of patients with VTEC is determination of duration of ACT. Aim. To study possibilities of prolonged anticoagulation therapy and secondary prevention of venous thromboembolic complications taking into consideration modern variants of drug therapy, on the basis of literature data. Search for literature was conducted in Medline and Elibrary databases including materials published in 2020. Randomized clinical and observational studies and meta-analyses, concerning prolonged therapy and secondary prevention of VTEC with vitamin K antagonists (VKA), peroral anticoagulants (POAC), sulodexide and aspirin, were analyzed. As it is evidenced by patho-physiological and epidemiological data, risk of VTEC recurrence in most patients is not resolved after the first 6 months of treatment with anticoagulants. In such situations it is reasonable to prolong anticoagulation for an indefinite period of time. However, sometimes a limiting factor for prolonged therapy with anticoagulants is bleedings caused by prolonged anticoagulation, sometimes leading to lethal outcome. Therefore, duration of treatment in the long-term period after an acute episode may rest on the balance between the risk of development of recurrence of venous thrombosis and bleeding, evaluated with the help of scales. The main achievement of recent years regarding prolonged therapy and secondary prevention of VTEC, are POAC, which in fact are new and alternative drugs that permitted the emergence of serious evidential basis in the range of means for treatment of this category of patients, sulodexide drug has appeared characterized by the minimal rate of development of large and clinically significant bleedings. Conclusion. The emergence of serious evidential basis for POAC with improved safety profiles, different pharmacokinetic profiles and dosage regimens, including sulodexide that has been actively used in recent years for secondary prevention of VTEC, will permit clinicians to differentially approach treatment of different clinical variants of venous thrombosis, to improve the results of therapy taking into account evaluation of the individual risk and comorbid diseases, and compliance of patients.

Thrombophilia and New Anticoagulant Drugs

Hematology ◽  
2004 ◽  
Vol 2004 (1) ◽  
pp. 424-438 ◽  
Author(s):  
Jeffrey I. Weitz ◽  
Saskia Middeldorp ◽  
William Geerts ◽  
John A. Heit
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Phase Ii ◽  
Anticoagulation Therapy ◽  
Factor Xa ◽  
Thrombin Inhibitors ◽  
First Episode ◽  
Direct Thrombin Inhibitors ◽  
Risk Of Recurrence ◽  
Phase Ii And Iii

Abstract Venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is the result of an imbalance among procoagulant, anticoagulant and profibrinolytic processes. This imbalance reflects a complex interplay between genetic and environmental or acquired risk factors. Genetic thrombophilic defects influence the risk of a first episode of thrombosis. How these defects influence the risk of recurrence in patients whose first episode of venous thromboembolism was unprovoked is less certain. Thus, when anticoagulants are stopped, patients with unprovoked venous thromboembolism have a risk of recurrence of at least 7% to 10% per year, even in the absence of an underlying thrombophilic defect. Consequently, there is a trend toward longer durations of anticoagulation therapy for these patients, which is problematic given the limitation of existing anticoagulants. This chapter provides an overview of the thrombophilic defects and how they influence the risk of venous thromboembolism. The chapter also details advances in anticoagulant therapy, focusing on new inhibitors of factor Xa and thrombin. In Section I, Dr. Saskia Middeldorp describes the various thrombophilic defects and reviews their relative importance in the pathogenesis of a first episode of venous thromboembolism. She then discusses the influence of these defects on the risk of recurrent thrombotic events in patients with unprovoked venous thromboembolism and in those whose thrombosis occurred in association with a known risk factor, such as surgery. In Section II, Dr. William Geerts reviews the pharmacology of new parenteral and oral factor Xa inhibitors and describes the results of the Phase II and III clinical trials with these agents. He then provides perspective on the potential advantages and drawbacks of these drugs for the prevention and treatment of venous thromboembolism. In Section III, Dr. John Heit focuses on direct thrombin inhibitors. He discusses their mechanism of action and compares and contrasts their pharmacological profiles prior to describing the results of Phase II and III clinical trials. Dr. Heit then provides perspective on the potential advantages and limitations of these drugs relative to existing anticoagulants.

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