The diagnosis and treatment of venous thromboembolism

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 457-463 ◽  
Author(s):  
Philip Wells ◽  
David Anderson
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Pretest Probability ◽  
Low Molecular Weight ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Venous thromboembolism (VTE) is a common condition that can lead to complications such as postphlebitic syndrome, chronic pulmonary artery hypertension, and death. The approach to the diagnosis of has evolved over the years and an algorithm strategy combining pretest probability, D-dimer testing, and diagnostic imaging now allows for safe, convenient, and cost-effective investigation of patients. Patients with low pretest probability and a negative D-dimer can have VTE excluded without the need for imaging. The mainstay of treatment of VTE is anticoagulation, whereas interventions such as thrombolysis and inferior vena cava filters are reserved for special situations. Low-molecular-weight heparin has allowed for outpatient management of most patients with deep vein thrombosis at a considerable cost savings to the health care system. Patients with malignancy-associated VTE benefit from decreased recurrent rates if treated with long-term low-molecular-weight heparin. The development of new oral anticoagulants further simplifies treatment. The duration of anticoagulation is primarily influenced by underlying cause of the VTE (whether provoked or not) and consideration of the risk for major hemorrhage. Testing for genetic and acquired thrombophilia may provide insight as to the cause of a first idiopathic deep vein thrombosis, but the evidence linking most thrombophilias to an increased risk of recurrent thrombosis is limited.

Outpatient Treatment of Pulmonary Embolism with Dalteparin

2000 ◽  
Vol 83 (02) ◽  
pp. 209-211 ◽  
Author(s):  
D. Anderson ◽  
B. Morrow ◽  
L. Gray ◽  
D. Touchie ◽  
P. S. Wells ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Outpatient Management ◽  
Medical Reason ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryPulmonary embolism is a common complication of deep vein thrombosis. It has been established that low molecular weight heparin may be used to treat deep vein thrombosis or pulmonary embolism and randomized studies have established that outpatient management of deep vein thrombosis with low molecular weight heparin is at least as effective as in-hospital management with unfractionated heparin.This was a prospective cohort study of eligible patients with pulmonary embolism managed as outpatients using dalteparin (200 U/kg s/c daily) for a minimum of five days and warfarin for 3 months. Outpatients included those managed exclusively out of hospital and those managed initially for 1-3 days as inpatients who then completed therapy o out of hospital. Reasons for admission included hemodynamic instability; hypoxia requiring oxygen therapy; admission for another medical reason; severe pain requiring parenteral analgesia or high risk of major bleeding. Patients were followed for three months for clinically apparent recurrent venous thromboembolism and bleeding.Between three teaching hospitals, a total of 158 patients with pulmonary embolism were identified. Fifty patients were managed as inpatients and 108 as outpatients. Of the outpatients, 27 were managed for an average of 2.5 days as inpatients and then completed dalteparin therapy as outpatients. The remaining 81 patients were managed exclusively as outpatients with dalteparin. For all outpatients the overall symptomatic recurrence rate of venous thromboembolism was 5.6% (6/108) with only 1.9% (2/108) major bleeds. There were a total of four deaths with none due to pulmonary embolism or major bleed.This prospective study suggests that outpatient management of pulmonary embolism is feasible and safe for the majority of patients.

scholarly journals Prevention of subclinical deep vein thrombosis in abdominal surgeries

2018 ◽  
Vol 5 (7) ◽  
pp. 2475
Author(s):  
Tazeem M. D. ◽  
Wasim M. D. ◽  
Sabia Amin ◽  
Tahmida Ali
Keyword(s):  
Molecular Weight ◽  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Low Molecular Weight Heparin ◽  
Lower Limbs ◽  
Low Molecular Weight ◽  
Vein Thrombosis ◽  
Group I ◽  
Deep Vein ◽  
D Dimer

Background: Deep vein thrombosis (DVT) is a common but elusive illness that can result in disability and death if not recognized and treated effectively. The reported incidence has not changed much over past couple of decades. The aim of this study was to identify the risk of deep vein thrombosis related to the number of days of immobility and the role of low molecular weight heparin in the prevention of deep vein thrombosis.Methods: A total of hundred (n=100) patients undergoing laparotomy were studied in the post-operative period between January 2014 and December 2016. Patients were divided into two groups alternatively; Group I patients did not receive any DVT prophylaxis and Group II patients were given low molecular weight heparin once a day till mobilization. From 3rdPOD, all the patients were evaluated with detailed history and lower limb examination. D-dimer study was done in all the patients and if positive then followed by Color Venous Doppler. Regular follow-ups were done weekly once for a month, every two weeks for next month and once a month thereafter, minimum for 6 months.Results: A total of hundred (n=100) patients, including 65 men and 35 women, with median age of 40 years underwent laparotomies in 2 years by a single unit. The incidence of Lower Limb DVT in Group I was 8%. The risk factors associated with DVT were sex, BMI, smoking and Malignancy. The signs and symptoms associated with DVT were swelling of lower limbs, pain and tenderness, fever and Homan’s and Moses signs. The D-dimer test results were positive in 9 patients. Color Venous Doppler identified DVT in 8 patients. On regular follow- ups, remissions of clinical symptoms were recorded and repeat Doppler scans showed recanalization in all the patients after 6 months.Conclusions: Deep Vein Thrombosis is multifactorial, and post-operative patients account for majority of cases. Early mobilization and Prophylactic Low Molecular Heparin prevents DVT in abdominal surgeries.

Low Molecular Weight Heparin and Compression Stockings in the Prevention of Venous Thromboembolism in Neurosurgery

1996 ◽  
Vol 75 (02) ◽  
pp. 233-238 ◽  
Author(s):  
M T Nurmohamed ◽  
A M van Riel ◽  
C M A Henkens ◽  
M M W Koopman ◽  
G T H Que ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Compression Stockings ◽  
Vein Thrombosis ◽  
Neurosurgical Patients ◽  
Deep Vein

SummaryPerioperative anticoagulant prophylaxis for postoperative venous thromboembolism (VTE) in neurosurgical patients has not gained wide acceptance due to the fear of intracranial bleeding. Physical methods give a worthwhile reduction of postoperative VTE but there still remains a substantial residual incidence. In other clinical indications, low molecular weight heparins have proven to be effective for prophylaxis of VTE when administered postoperatively, with the advantage of no bleeding enhancement during surgery.Therefore, we performed a multicentre, randomized, double-blind trial in neurosurgical patients to investigate the efficacy and safety of adding a low molecular weight heparin (LMWH), nadroparin, initiated postoperatively, to graduated compression stockings in the prevention of VTE. Deep-vein thrombosis was detected by mandatory venography. Bleeding was determined according to pre-defined objective criteria for major and minor episodes.An adequate bilateral venogram was obtained in 166 of 241 LMWH patients (68.9%) and 179 of 244 control patients (73.4%). A total of 31 of 166 LMWH patients (18.7%) and 47 of 179 control patients (26.3%) had VTE up to Day 10 postoperatively (p = 0.047). The relative risk reduction (RRR) was 28.9%. The rates for proximal deep-vein thrombosis/pulmonary embolism were 6.9% and 11.5% for the two groups, respectively (RRR: 40.2%; p = 0.065).Secondary analyses involved all VTE up to day 56 post-surgery which was detected in 33 patients of 241 in the LMWH group (13.7%) and 51 of 244 control patients (20.9%; RRR 34.5%; p = 0.018). The corresponding percentages for proximal deep-vein thrombosis/pulmonary embolism were 5.8% and 10.2% for the two groups, respectively, giving a RRR of 43.3%; p = 0.036. Major bleeding complications, during the treatment period, occurred in six low molecular weight heparin treated patients (2.5%) and in two control patients (0.8%); p = 0.087.A higher mortality was observed in the low molecular weight heparin group over the 56-day follow-up period (22 versus 10; p = 0.026). However, none of these deaths was judged by a blinded adjudication committee to be related to the study drug.In conclusion, this study demonstrates that the low molecular weight heparin, nadroparin, added to graduated compression stockings results in a clinically significant decrease in VTE without inducing any significant increase of major bleeding.

Comparison of a once Daily with a twice Daily Subcutaneous Low Molecular Weight Heparin Regimen in the Treatment of Deep Vein Thrombosis

1998 ◽  
Vol 79 (05) ◽  
pp. 897-901 ◽  
Author(s):  
Bernard A. Charbonnier ◽  
Jean-Noël Fiessinger ◽  
J. D. Banga ◽  
Ernst Wenzel ◽  
Pascal d’Azemar ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Daily Regimen ◽  
Once Daily ◽  
Daily Group ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryBackground: Clinical trials have been performed to compare with standard heparin a once or a twice daily regimen of low-molecular-weight heparin but no direct comparison has been done between these two low-molecular-weight heparin regimens in terms of efficacy and safety with a long-term clinical evaluation.Methods: Patients with proximal deep vein thrombosis, confirmed by venography were randomly assigned to either nadroparin (10,250 AXa IU/ml) twice daily or nadroparin (20,500 AXa IU/ml) once daily for at least 5 days. Regimens were adjusted to bodyweight. Oral anticoagulants were started on day 1 or 2 and continued for 3 months. Patients were followed up for 3 months. The composite outcome of venous thromboembolism and death possibly related to pulmonary embolism was the primary measure of efficacy. Major bleeding was the principal measure of safety. The study was designed to show equivalence between the two regimens.Results: Recurrent thromboembolic events or death possibly related to pulmonary embolism were reported in 13 patients in the once daily group (4.1%) and in 24 patients of the twice daily group (7.2%): (absolute difference 3.1% in favor of the once daily regimen; 95% confidence interval -6.6%, +0.5%). Major bleeding episodes during nadroparin treatment occurred in 4 (1.3%) and 4 patients (1.2%) in the once and twice daily groups, respectively.Conclusions: A nadroparin regimen of one injection per day is at least as effective and safe as the same total daily dose divided over two injections for the treatment of acute deep vein thrombosis.

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