Tinzaparin in Outpatients with Pulmonary Embolism or Deep Vein Thrombosis

2005 ◽  
Vol 39 (7-8) ◽  
pp. 1182-1187 ◽  
Author(s):  
William E Dager ◽  
Jeff H King ◽  
Jennifer M Branch ◽  
Stacey L Chow ◽  
Ruby E Ferrer ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Warfarin Therapy ◽  
Outpatient Setting ◽  
Minor Bleeding ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
The University ◽  
Deep Vein

BACKGROUND The low-molecular-weight heparins (LMWHs) have been shown to be effective in the outpatient treatment of deep vein thrombosis (DVT). Data regarding outpatient use of any LMWH in pulmonary embolism (PE) or tinzaparin in DVT while transitioning therapy to a vitamin K antagonist are limited. OBJECTIVE To determine the safety and efficacy of tinzaparin in patients with either DVT or PE being transitioned to warfarin during LMWH therapy in the outpatient setting. METHODS All patients who were treated with at least one outpatient dose of tinzaparin for venous thromboembolism (VTE) were identified. Charts of all patients followed within the University of California Davis healthcare system were reviewed. The incidence of bleeding and recurrent thromboembolism over a minimum of the first 4 weeks to a maximum of 12 weeks after initiating anticoagulation was assessed. RESULTS A total of 178 patients with acute VTE were treated with tinzaparin, and outcomes could be determined in 140 cases. Forty-seven percent of these patients had objectively documented PE. Only one (0.7%) case of recurrent VTE was observed. Major bleeding was documented in 5 (3.6%) and minor bleeding in 8 (5.8%) patients. Two bleeding events, both major, occurred during tinzaparin therapy. CONCLUSIONS Outpatient use of tinzaparin during transition to warfarin therapy in the treatment of VTE, including PE, appears to be feasible in patients who are judged candidates for home therapy.

Comparative Efficacy and Safety Of Dabigatran Etexilate and Rivaroxaban For The Treatment Of Deep Vein Thrombosis and Pulmonary Embolism

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4807-4807
Author(s):  
Andreas Clemens ◽  
Shaun Abeysinghe ◽  
Ann-Katrin Gonschior ◽  
Volker Hösel ◽  
Sarah Lock ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Lower Risk ◽  
Dabigatran Etexilate ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
All Cause Mortality ◽  
Meta Analyses ◽  
Deep Vein

Objective Two novel oral anticoagulants recently have been investigated for the treatment of deep vein thrombosis and/or pulmonary embolism: dabigatran etexilate (dabigatran) and rivaroxaban. The aim of this analysis was to compare their efficacy and safety. Methods Randomized, controlled trials investigating dabigatran or rivaroxaban were identified by a systematic review. Direct meta-analyses and anchored (adjusted) indirect comparisons (AICs) were performed using aggregated results for the following endpoints for the overall treatment duration: first recurrent symptomatic venous thromboembolism (VTE) or VTE-related death, major bleeding events (MBEs), MBEs or clinically relevant bleeding events (CRBEs), and all-cause mortality. Results Four trials were identified; two compared dabigatran with warfarin and two compared rivaroxaban with vitamin K antagonists. The results of the trials, and the direct meta-analyses of the two dabigatran trials and the two rivaroxaban trials, are presented in Table 1. Overall, there was little evidence of heterogeneity in treatment effects among the RE-COVER trials (VTE or VTE-related death, MBEs, MBEs or CRBEs, all-cause mortality: P= 0.82, 0.67, 0.97, 0.97, respectively; I2= 0%). There was some evidence of heterogeneity among the EINSTEIN trials for VTE or VTE-related death (P=0.11; I2=61.9%) and all-cause mortality (P=0.16; I2=50%), but none for MBEs and MBEs/CRBEs with I2= 0% (P= 0.43, 0.47). In the AICs, sensitivity analyses were performed to explore potential trial heterogeneity arising from differences in the type of index VTE and time with an international normalized ratio between 2.0 and 3.0. AIC results suggested that dabigatran was associated with a lower risk of MBEs/CRBEs than rivaroxaban (upper 95% confidence limits for relative risks were less than 1.00). There was no evidence to suggest a difference between dabigatran and rivaroxaban with respect to prevention of recurrent symptomatic VTE or VTE-related death, MBEs, or all-cause mortality. Conclusions Dabigatran may be associated with a lower risk of major or clinically relevant bleeding; there was no evidence to suggest a difference among drugs in prevention of recurrent VTE, MBEs, or overall mortality. Disclosures: Clemens: Boehringer Ingelheim Pharma GmbH & Co. KG: Employment. Off Label Use: Dabigatran etexilate, direct oral thrombin inhibitor, anticoagulant effect; indications for stroke prevention in atrial fibrillation patients in about 90 countries including US; indication for primary VTE prevention in total hip or knee replacement patients in about 100 countries excluding US. Abeysinghe:Boehringer Ingelheim International GmbH: Consultancy. Gonschior:Boehringer Ingelheim GmbH: Employment. Hösel:Boehringer Ingelheim GmbH: Consultancy. Lock:Boehringer Ingelheim International GmbH: Consultancy. Wolowacz:Boehringer Ingelheim International GmbH: Consultancy. Woods:Boehringer Ingelheim International GmbH: Consultancy. Zimovetz:Boehringer Ingelheim International GmbH: Consultancy.

scholarly journals Real-World Rates of In-hospital and Postdischarge Deep-Vein Thrombosis and Pulmonary Embolism in At-Risk Medical Patients in the United States

2011 ◽  
Vol 17 (6) ◽  
pp. 611-619 ◽  
Author(s):  
Alpesh N. Amin ◽  
Jay Lin ◽  
Stephen Thompson ◽  
Daniel Wiederkehr
Keyword(s):  
Infectious Disease ◽  
At Risk ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
The United States ◽  
Outpatient Setting ◽  
Medical Patients ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Deep Vein

Hospitalized medical patients are at risk of deep-vein thrombosis (DVT) and pulmonary embolism (PE). We evaluated inpatient and postdischarge DVT/PE and thromboprophylaxis rates in US medical patients, using patient admissions from January 2005 to November 2007 in the Premier Perspective™-i3 Pharma Informatics database. Among 15 721 patients with cancer, congestive heart failure, severe lung disease, and infectious disease, 39.0% received inpatient thromboprophylaxis, with the highest rate in patients with cancer (51.9%). In all, 3.4% received outpatient pharmacological prophylaxis. Mean ± SD prophylaxis duration was 2.2 ± 5.7 days. Overall, 3.0% of inpatients had symptomatic DVT/PE, and an additional 1.1% of patients were rehospitalized for DVT/PE or treated in the outpatient setting. Patients with infectious disease had the highest rate of DVT/PE (4.6%). Inpatient DVT/PE and prophylaxis rates of the different medical conditions had a negative correlation ( R 2 = 0.72). This analysis demonstrates the burden of DVT/PE and highlights the underuse of thromboprophylaxis across the continuum of care.

The Risk and Efficacy of Anticoagulant Therapy in the Treatment of Thromboembolic Complications in Patients with Primary Malignant Brain Tumors

Neurosurgery ◽  
1990 ◽  
Vol 27 (1) ◽  
pp. 74-77 ◽  
Author(s):  
Eric Altschuler ◽  
Hans Moosa ◽  
Robert G. Selker ◽  
Frank T. Vertosick
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Anticoagulant Therapy ◽  
Warfarin Therapy ◽  
Oral Anticoagulant Therapy ◽  
Effective Means ◽  
Thromboembolic Complications ◽  
Intratumoral Hemorrhage ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Twenty-three patients with malignant glial neoplasms were treated with anticoagulant therapy for thromboembolic complications. Fifteen patients had deep vein thrombosis alone, and 8 patients had both deep vein thrombosis and pulmonary embolism. Serum prothrombin times were maintained at 1.25 times control for an average of 5.8 months per patient, for a total patient exposure to warfarin therapy of 132 patient-months (11 patient-years). Only 1 patient suffered a recurrent pulmonary embolism, and this occurred during an episode of gastrointestinal bleeding, when anticoagulant therapy had to be discontinued prematurely. All patients were followed with serial computed tomographic or magnetic resonance imaging scans, and no patient showed radiographic evidence of intratumoral hemorrhage either during or after warfarin therapy. One patient, who died from a large recurrent glioblastoma, was found at autopsy to have scattered foci of intratumoral hemorrhage. This series, together with a review of the available literature, suggests that oral anticoagulant therapy is both a safe and effective means of treating thromboembolic complications in patients with residual malignant glial tumors.

scholarly journals Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

2019 ◽  
Vol 25 ◽  
pp. 107602961882119 ◽  
Author(s):  
Tao Tang ◽  
Linyi Chen ◽  
Jinhui Chen ◽  
Tong Mei ◽  
Yongming Lu
Keyword(s):  
Clinical Trials ◽  
Deep Vein Thrombosis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference ◽  
Deep Vein

Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I2 = 0%), thrombus score ( P = .01; I2 = 0%), the duration in the hospital ( P = .03; I2 = 64%), and thrombolysis time ( P < .00001, I2 = 0%). There was no significant difference in valvular incompetence events ( P = .21; I2 = 0%), minor bleeding events ( P = .59; I2 = 0%), stent events ( P = .09; I2 = 24%), and clot reduction grade I events ( P = .16; I2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I2 = 0%) as well as for PMT alone versus CDT group ( P = .88, I2 = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.

Intensity of Warfarin Anticoagulation as an Independent Predictor of 6-Month Recurrence after Deep Vein Thrombosis or Pulmonary Embolism: A Population-Based Cohort Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 718-718
Author(s):  
John A. Heit ◽  
Brian K. Lahr ◽  
Tanya M. Petterson ◽  
Kent R. Bailey ◽  
L. Joseph Melton
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Warfarin Therapy ◽  
Independent Predictor ◽  
Heparin Therapy ◽  
Independent Effect ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Anticoagulation Intensity ◽  
Active Cancer

Abstract Background: Most trials of standard heparin and warfarin therapy used the 3- to 6-month cumulative incidence of venous thromboembolism (VTE) recurrence as the primary efficacy outcome. However, the independent effect of warfarin anticoagulation intensity on VTE recurrence after controlling for other predictors of recurrence (e.g., active cancer, neurological disease with extremity paresis) is uncertain. Objectives: To test warfarin anticoagulation intensity, using international normalized ratio (INR) data, as an independent predictor of 6-month VTE recurrence. Measurements: Using the resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN residents with an incident deep vein thrombosis or pulmonary embolism over the 14-year period, 1984–1997 (n=1165). We followed each case (conditional on surviving 14 days without VTE recurrence) forward in time through their complete medical records in the community for first VTE recurrence. We collected date of incident VTE onset, start and stop dates of heparin and warfarin, and date, time and result of all INR values. Using these and other measures of standard warfarin therapy as time-dependent variables, we tested the intensity of warfarin anticoagulation (expressed as the cumulative percent of time with an INR at or above 2.0 [or at or above 1.5] while on warfarin) as an independent predictor of 6-month VTE recurrence while controlling for other baseline characteristics using Cox proportional hazards modeling. Results: Of the 1165 patients, 1026 (88%) and 989 (85%) received heparin and warfarin, respectively, and 254 (22%) developed recurrent VTE over 5461 person-years of follow-up; 52 recurred within 15–180 days. In the multivariate analysis, the independent predictor of 6-month recurrence was active cancer (HR=3.98, 95% CI: 2.12, 7.45; p&lt;0.01); age, gender, body mass index and neurologic disease with extremity paresis were not predictors of VTE recurrence. In models that included presence or absence of warfarin therapy along with proportion of time with an INR ≥2, this latter intensity variable was protective (HR=0.16 for 100% versus 0% of time, p=0.02) against recurrence, while mere presence of warfarin therapy (HR =0.72, p= 0.56) was not. Similar results were obtained when intensity was represented as proportion of time with an INR ≥1.5 (HR=0.17, p=0.02). Interestingly, a therapeutic APTT within the first 24 hours of heparin therapy also was protective against 6-month recurrence (HR=0.45, p=0.02). Conclusions: Active cancer is an independent predictor of 6-month VTE recurrence. Warfarin therapy with a higher proportion of time with an INR ≥1.5 or ≥2 offers similar protection against recurrence. A rapid heparin-response (as reflected by a therapeutic APTT within 24 hours of heparin therapy) also is a predictor of reduced 6-month recurrence, possibly reflecting lower factor VIII activity at the acute incident VTE event. Gender is not a predictor of long-term recurrence.

Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Continuous Infusion ◽  
High Speed ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Follow Up ◽  
Valve Function ◽  
Rotating Impeller ◽  
Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

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