scholarly journals Rivaroxaban for the treatment of cerebral venous thrombosis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Esmaeili ◽  
Meysam Abolmaali ◽  
Sobhan Aarabi ◽  
Mohammad Reza Motamed ◽  
Samira Chaibakhsh ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Term Treatment ◽  
Background Information ◽  
Minor Bleeding ◽  
Long Term Treatment ◽  
Significant Difference

Abstract Background New Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk. There is a lack of evidence on the effectiveness and safety of Rivaroxaban in Cerebral venous thrombosis (CVT). This study aims to assess the effectiveness and bleeding risk of Rivaroxaban in comparison with Warfarin for the treatment of CVT. Materials and methods 36 patients with diagnosis of CVT were included. Clinical and background information was assessed on admission and patients were followed for at least 12 months. Measured outcomes were modified Rankin Scale (mRS), evidence of recanalization on contrast-enhanced Brain MR venography (MRV) and major or minor bleeding. Patients were divided into two groups according to the type of oral anticoagulant (Rivaroxaban vs Warfarin). Groups were compared in terms of final outcomes and side effects. Result Overall, 13 (36.11%) patients received Warfarin and 23 (63.89%) received Rivaroxaban. Optimal mRS score (0–1) was attained in 9 of 10 (90%) of patients treated with Rivaroxaban and 19 of 22 (86.36%) of patients received Warfarin. MRV showed complete or partial recanalization in 12 of 14 (85.71%) patients treated with Rivaroxaban and all patients in the Warfarin group. There was no significant difference between the two groups in terms of major and minor hemorrhage. Conclusion Rivaroxaban holds promise for the treatment of CVT.

scholarly journals The Role of Tinzaparin in Oncology

2017 ◽  
Vol 24 (5) ◽  
pp. 697-707 ◽  
Author(s):  
Evangelos P. Dimakakos ◽  
Ioannis Vathiotis ◽  
Konstantinos Syrigos
Keyword(s):  
Severe Renal Impairment ◽  
Vitamin K Antagonists ◽  
Term Treatment ◽  
Current Data ◽  
Postthrombotic Syndrome ◽  
Minor Bleeding ◽  
Preclinical Research ◽  
Bleeding Events ◽  
Patients With Cancer ◽  
Long Term Treatment

Current guidelines recommend low-molecular-weight heparin treatment in patients with cancer with established venous thromboembolism (VTE). The aim of this article was to study the pharmacological properties and effectiveness of tinzaparin in patients with cancer as well as its potential anticancer properties. A search of PubMed and ScienceDirect databases up to March 2016 was carried out to identify published studies that detect the properties and use of tinzaparin in oncology. Protamine sulfate partially (60% to 65%) neutralized tinzaparin’s anti-Xa activity. No dose adjustment of tinzaparin is needed even in patients with severe renal impairment and Creatinine Clearance ≥20 mL/min. Tinzaparin demonstrated a statistically significant decline in VTE recurrence at 1 year post the index thromboembolic event. A statistically significant reduction in minor bleeding rates was also described, whereas major bleeding events did not decrease in patients with cancer treated with tinzaparin versus those who received vitamin K antagonists. Tinzaparin treatment in patients suffering from deep vein thrombosis reduced the incidence of postthrombotic syndrome and venous ulcers. Tinzaparin’s ability to prevent both metastatic dissemination of cancer cells and tumor angiogenesis has been delineated in preclinical research. Current data show that tinzaparin is safe and efficacious either for short-term or for long-term treatment of VTE in patients with cancer. Clinical trials are needed in order to examine the utility of tinzaparin in primary prevention of VTE and validate its potential anticancer advantages exhibited in preclinical research.

scholarly journals Current Recommendations for the Management of Cancer-Associated Venous Thromboembolism

2021 ◽  
Vol 7 (2) ◽  
pp. 27-38
Author(s):  
Katalin Makó
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Risk ◽  
Term Treatment ◽  
Long Term Treatment ◽  
High Bleeding Risk ◽  
Cancer Associated Thrombosis

Abstract Cancer-associated thrombosis (CAT) is a major cause of death in oncological patients. The mechanisms of thrombogenesis in cancer patients are not fully established, and it seems to be multifactorial in origin. Also, several risk factors for venous thromboembolism (VTE) are present in these patients such as tumor site, stage, histology of cancer, chemotherapy, surgery, and immobilization. Anticoagulant treatment in CAT is challenging because of high bleeding risk during treatment and recurrence of VTE. Current major guidelines recommend low molecular weight heparins (LMWHs) for early and long-term treatment of VTE in cancer patients. In the past years, direct oral anticoagulants (DOACs) are recommended as potential treatment option for VTE and have recently been proposed as a new option for treating CAT. This manuscript will give a short overview of risk factors involved in the development of CAT and a summary on the recent recommendations and guidelines for treatment of VTE in patients with malignancies, discussing also some special clinical situations (e.g. renal impairment, catheter-related thrombosis, and thrombocytopenia).

Dabigatran Reversal with Idarucizumab in an Emergency Lumbar Puncture: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Ornella Spagnolello ◽  
Federica Letteri ◽  
Anne Falcou ◽  
Lorena Cipollone ◽  
Manuela De Michele ◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Previous History ◽  
Antibody Fragment ◽  
Invasive Procedure ◽  
Bleeding Risk ◽  
Term Treatment ◽  
Emergency Setting ◽  
Long Term Treatment

Introduction: The widespread use of direct oral anticoagulants (DOACs) has been increasing the conditions in which emergency physicians are forced to rapidly reverse anticoagulation in case of life-threatening bleeding or need of urgent surgery or invasive procedures. The recent approval of Idarucizumab, a humanized monoclonal antibody fragment (Fab), offered the opportunity to rapidly and safely neutralize the anticoagulant effect of Dabigatran. However, real-world experience of its effective use in different emergency setting is now required. Lumbar Puncture (LP) is recognized as an invasive procedure at major bleeding risk and is, therefore, contraindicated in anticoagulated patients. Conclusion: We report a successful use of Idarucizumab in an emergency LP of a young woman with a possible diagnosis of encephalitis and a previous history of venous thromboembolism on long-term treatment with Dabigatran 150 mg twice a day.

scholarly journals Urokinase Therapy in Neonates with Catheter Related Central Venous Thrombosis

1995 ◽  
Vol 73 (02) ◽  
pp. 180-185 ◽  
Author(s):  
M L G Wever ◽  
K D Liem ◽  
W B Geven ◽  
R B Tanke
Keyword(s):  
Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Prophylactic Antibiotic ◽  
Fibrinolytic Therapy ◽  
Term Treatment ◽  
Central Venous ◽  
Long Term Treatment ◽  
Central Venous Thrombosis ◽  
Prophylactic Antibiotic Therapy ◽  
Therapy Success

SummaryThe results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with catheter related central venous thrombosis. Complete thrombolysis could be achieved in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen in 10 patients (38%). Therapy success was influenced by age, size and location of the thrombus. Coincidence of infection occurred in 16 patients (62%). Mild hemorrhagic complications were seen in 2 patients (8%), no other significant side effects were observed. Nine patients with residual thrombosis were treated with oral anticoagulants following urokinase resulting in resolution of the thrombus in 6 patients within 3 months (67%). The incidence of asymptomatic recurrent thrombosis was high (28%). Urokinase might be an effective and safe treatment for central venous thrombosis in neonates. Prophylactic antibiotic therapy during the infusion of urokinase and long-term treatment with oral anticoagulants after thrombosis are advisable. Early detection of thrombosis might enhance the success rate of fibrinolytic therapy. Therefore, we strongly recommend routine echocardiographic screening of central venous catheters.

Direct Oral Anticoagulants for the Treatment of Cerebral Venous Thrombosis

2019 ◽  
Vol 48 (1-2) ◽  
pp. 32-37 ◽  
Author(s):  
Antoine Lurkin ◽  
Laurent Derex ◽  
Alexandra Fambrini ◽  
Laurent Bertoletti ◽  
Magali Epinat ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Randomized Clinical Trials ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Individual Risk ◽  
University Hospitals ◽  
Imaging Results ◽  
Venous Recanalization

Background: Cerebral venous thrombosis (CVT) is an uncommon neurological condition usually treated with heparin followed by oral vitamin K antagonists (VKAs). In patients with venous thromboembolism (VTE), compared to VKAs, direct oral anticoagulants (DOACs) offer several advantages. However, there is little data concerning their use in managing CVT. Aims: This retrospective observational study pursued 2 objectives: (1) to investigate clinical characteristics of CVT patients treated with heparin + DOACs vs. heparin + standard treatment; (2) to compare clinical outcomes. Methods: Consecutive CVT patients recruited from January 2016 to March 2018 in 2 French university hospitals (Lyon, Saint-Etienne), and treated with DOACs or VKAs were identified. Radiological evolution, VTE, hemorrhagic events, and antithrombotic medication were recorded. Functional outcome was assessed by the modified Rankin scale score and venous recanalization was assessed by magnetic resonance imaging. Results: Overall, 41 patients were included: 25 (61%) received VKAs and 16 (39%) DOACs. We identified no clinical or radiological features explaining the physicians’ preference for a specific anticoagulation treatment, and age, initial clinical presentation, radiological severity, and individual risk factors thus unlikely guided the choice of anticoagulant. No DOAC patient exhibited clinical or radiological thrombosis aggravation, and the thrombosis completely vanished in 6 (40%). Two of the VKA-treated patients (28.6%) demonstrated complete venous recanalization, whereas 3 others experienced clinical or radiological aggravation versus baseline. There was no major bleeding leading to hospitalization in both groups. Conclusion: The collected data on DOAC efficacy and safety in CVT management appear encouraging, yet needs to be confirmed by larger prospective randomized clinical trials.

scholarly journals Low molecular weight heparin versus oral anticoagulants in the long-term treatment of deep venous thrombosis

2001 ◽  
Vol 33 (1) ◽  
pp. 77-90 ◽  
Author(s):  
Paloma López-Beret ◽  
Antonio Orgaz ◽  
Juan Fontcuberta ◽  
Manuel Doblas ◽  
Adela Martinez ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Term Treatment ◽  
Low Molecular Weight ◽  
Long Term Treatment

Postintervention duration of anticoagulation in venous surgery

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 105-111 ◽  
Author(s):  
A J Ten Cate-Hoek ◽  
M H Prins ◽  
C H A Wittens ◽  
H Ten Cate
Keyword(s):  
Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Treatment Modalities ◽  
Individual Risk ◽  
Recurrent Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Treatment ◽  
Venous Surgery ◽  
New Treatment

For a substantial proportion of patients with deep venous thrombosis (DVT), current treatment strategies are suboptimal and new treatment options are needed. Especially for the group of patients who are at the highest risk for post-thrombotic syndrome, new treatment modalities such as catheter-directed thrombolysis and additional stenting are being investigated. With current clinical studies addressing new technical options, the medical management of patients following these interventions deserves attention. The duration of anticoagulant treatment following surgical or radiological interventions for DVT seems not to be influenced by the presence of a venous stent. According to recent ACCP 2012 guidelines the anticoagulant management in patients who have had any method of thrombus removal performed, the same intensity and duration of anticoagulant therapy as in comparable patients who do not undergo thrombosis removal is recommended (Grade 1B). In the acute phase of thrombosis, irrespective of the technique and whether or not stenting is applied, immediate anticoagulation following the procedure is pertinent to reduce the risk of recurrent thrombosis and thrombus propagation. The long-term treatment duration after venous interventions therefore may be tailored based on common risk factors for recurrent thrombosis and the individual risk for bleeding. Selected thrombophilia factors, d-dimer assessment and residual venous thrombosis provide markers for recurrent DVT. Currently, vitamin K antagonists) provide the main anticoagulants for (prolonged) anticoagulation, while the new oral anticoagulants emerge as promising alternatives. In case prolonged anticoagulation after unprovoked DVT is not indicated, cardiovascular risk management is warranted because of an increased rate of arterial thrombotic events after DVT; aspirin may be indicated as secondary prevention against recurrent thrombosis (while providing primary prevention against arterial thrombosis).

The Effectiveness and the Safety of Rivaroxaban in Comparison with Vitamin K Antagonists During the Long-Term Treatment of Venous Thrombosis

Flebologiia ◽  
2016 ◽  
Vol 10 (1) ◽  
pp. 19 ◽  
Author(s):  
I. V. Schastlivtsev ◽  
K. V. Lobastov ◽  
V. E. Barinov ◽  
A. V. Vorontsova ◽  
S. V. Tsaplin ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Term Treatment ◽  
Long Term Treatment
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