scholarly journals Impact of Anticoagulation Therapy on the Risk of Pulmonary Embolism and Bleeding Events in Patients with Isolated Distal Deep-Vein Thrombosis

2021 ◽  
Author(s):  
Yorinari Ochiai ◽  
Tetsuo Yamaguchi ◽  
Chinatsu Komiyama ◽  
Takahide Kodama
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

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.

Deep Vein Thrombosis and Venous Thromboembolism in the Critically Ill

2017 ◽  
Author(s):  
Kathryn L. Butler ◽  
George Velmahos
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Vein Thrombosis ◽  
Vena Cava Filters ◽  
Deep Vein

Venous thromboembolism (VTE) poses unique diagnostic and therapeutic dilemmas in the intensive care unit (ICU). Immobility, inflammatory states, and trauma uniquely predispose surgical ICU patients to deep vein thrombosis and pulmonary embolism. Concurrently, the risks of perioperative and traumatic bleeding complicate management of VTE, with anticoagulation contraindicated in many scenarios. This review surveys the latest evidence in the diagnosis and management of VTE among critically ill surgical patients. It discusses evidence-based guidelines regarding diagnostic imaging, anticoagulation, prophylaxis, inferior vena cava filters, non–vitamin K oral anticoagulants, and surgical and catheter-based therapies. The review also examines the special challenges encountered when treating multisystem trauma patients.  Key words: anticoagulation therapy, deep vein thrombosis, pharmacoprophylaxis, pulmonary embolism, venous thromboembolism  

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 Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

2021 ◽  
Author(s):  
Sebastian Schellong ◽  
Walter Ageno ◽  
Ivan B. Casella ◽  
Kok Han Chee ◽  
Sam Schulman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Varicose Veins ◽  
Oral Anticoagulants ◽  
Patient Characteristics ◽  
Global Perspective ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

AbstractIsolated distal deep vein thrombosis (IDDVT) is presumed to be more benign than proximal DVT (PDVT) or pulmonary embolism (PE), suggesting a need for different management approaches. This subgroup analysis of the RE-COVERY DVT/PE global, observational study investigated patient characteristics, hospitalization details, and anticoagulant therapy in patients with IDDVT in real-world settings in 34 countries enrolled from January 2016 to May 2017. Data were analyzed descriptively according to the type and location of the index venous thromboembolism (VTE): IDDVT, PDVT ± distal DVT (DDVT), and PE ± DVT. Of the 6,095 eligible patients, 323 with DVT located outside the lower limb and no PE were excluded. Of the remaining 5,772 patients, 17.6% had IDDVT, 39.9% had PDVT ± DDVT, and 42.5% had PE ± DVT. IDDVT patients were younger and had fewer risk factors for VTE than the other groups. Other comorbidities were less frequent in the IDDVT group, except for varicose veins, superficial thrombophlebitis, and venous insufficiency. IDDVT patients were less likely to be diagnosed in an emergency department (22.3 vs. 29.7% for PDVT ± DDVT and 45.4% for PE ± DVT) or hospitalized for VTE (29.2 vs. 48.5% for PDVT ± DDVT and 75.0% for PE ± DVT). At hospital discharge or 14 days after diagnosis (whichever was later), non–vitamin K antagonist oral anticoagulants were the most commonly used anticoagulants (55.6% for IDDVT, 54.7% for PDVT ± DDVT, and 52.8% for PE ± DVT). Although differences in patient characteristics, risk factors, and clinical management were identified, anticoagulant treatment of IDDVT was almost equal to that of PDVT or PE. Prospective studies should investigate whether, in a global perspective, this is an appropriate use of anticoagulants. Trial registration number ClinicalTrials.gov NCT02596230.

scholarly journals Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

2017 ◽  
Vol 24 (7) ◽  
pp. 1134-1143 ◽  
Author(s):  
Yongming Lu ◽  
Linyi Chen ◽  
Jinhui Chen ◽  
Tao Tang
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Anticoagulation Therapy ◽  
Postthrombotic Syndrome ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference ◽  
Deep Vein

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein ( P < .00001; I2 = 44%) and reduce the risk of PTS ( P = .0002; I2 = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS ( P = .2; I2 = 59%). A reduced PTS risk was shown, however, in nonrandomized trials ( P < .00001; I2 = 47%). Meta-analysis showed that CDT can reduce severe PTS risk ( P = .002; I2 = 0%). However, CDT was not indicated to prevent mild PTS ( P = .91; I2 = 79%). A significant increase in bleeding events ( P < .00001; I2 = 33%) and pulmonary embolism (PE) ( P < .00001; I2 = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group ( P < .00001; I2 = 0%). There was no significant difference in death ( P = .09; I2 = 0%) or recurrent venous thromboembolism events ( P = .52; I2 = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

scholarly journals Deep Vein Thrombosis and Pulmonary Embolism in a Woman with Uterine Myoma

1970 ◽  
Vol 23 (2) ◽  
pp. 78-81
Author(s):  
R Nawaz ◽  
S Haque ◽  
K Shaha
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Anticoagulation Therapy ◽  
Rare Event ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Myoma ◽  
Uneventful Recovery ◽  
Vein Thrombosis ◽  
Deep Vein

Background:. Deep vein thrombosis and pulmonary embolism are rare complications of uterine myoma. There have been few reports on these associations. Case: A 41 year old para 1+0 presented with 20 weeks size fibroid uterus, which had compressed the pelvic veins and caused unilateral deep vein thrombosis of right leg with subsequent pulmonary embolism. After anticoagulation therapy, a total abdominal hysterectomy was performed, with an uneventful recovery. Conclusion: Although deep vein thrombosis and pulmonary embolism associated with uterine myoma is a rare event, it can be managed successfully with anticoagulants and hysterectomy. A uterine myoma with deep vein thrombosis and pulmonary embolism is an indication for hysterectomy. DOI: 10.3329/bjog.v23i2.4965 Bangladesh J Obstet Gynaecol, 2008; Vol. 23(2) : 78-81

Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis

2016 ◽  
Vol 115 (03) ◽  
pp. 608-614 ◽  
Author(s):  
Krishna Patel ◽  
Kevin Chagin ◽  
Pichapong Tunsupon ◽  
Pojchawan Yampikulsakul ◽  
Gautam V. Shah ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Cleveland Clinic ◽  
Proximal Deep Vein Thrombosis ◽  
Final Model ◽  
Vein Thrombosis ◽  
C Statistic ◽  
Two Factors ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

SummaryIsolated distal deep-vein thrombosis (DDVT) of the lower extremities can be associated with subsequent proximal deep-vein thrombosis (PDVT) and/or acute pulmonary embolism (PE). We aimed to develop a model predicting the probability of developing PDVT and/or PE within three months after an isolated episode of DDVT. We conducted a retrospective cohort study of patients with symptomatic DDVT confirmed by lower extremity vein ultrasounds between 2001–2012 in the Cleveland Clinic Health System. We reviewed all the ultrasounds, chest ventilation/perfusion and computed tomography scans ordered within three months after the initial DDVT to determine the incidence of PDVT and/or PE. A multiple logistic regression model was built to predict the rate of developing these complications. The final model included 450 patients with isolated DDVT. Within three months, 30 (7%) patients developed an episode of PDVT and/or PE. Only two factors predicted subsequent thromboembolic complications: inpatient status (OR, 6.38; 95 % CI, 2.17 to 18.78) and age (OR, 1.02 per year; 95 % CI, 0.99 to 1.05). The final model had a bootstrap bias-corrected c-statistic of 0.72 with a 95 % CI (0.64 to 0.79). Outpatients were at low risk (<4 %) of developing PDVT/PE. Inpatients aged ≥ 60 years were at high risk (> 10%). Inpatients aged < 60 were at intermediate risk. We created a simple model that can be used to risk stratify patients with isolated DDVT based on inpatient status and age. The model might be used to choose between anticoagulation and monitoring with serial ultrasounds.

scholarly journals TO ASSESS SAFETY OF WITHHOLDING ANTITHROMBOTIC THERAPY IN PATIENTS WITH LOW OR INTERMEDIATE PROBABILITY OF PULMONARY EMBOLISM

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Archi Mangal ◽  
Mahendra Kumar Arya ◽  
Devendra Kumar Khatana ◽  
Dr. Sheetal Singh
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Antithrombotic Therapy ◽  
Anticoagulation Therapy ◽  
Research Centre ◽  
Age Group ◽  
Colour Doppler ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Background & Method: The study was carried out in the Department of Radio diagnosis, Index Medical College, Hospital & Research Centre, Indore, M.P. including 100 chronic bedridden patients with an aim to assess safety of withholding antithrombotic therapy in patients with low or intermediate probability of pulmonary embolism. Result: Males represented about 62% of the entire sample. Majority of male patients were in age group 50 and above. Majority (29%) of female patients were of age group of 20 to 40 yrs. On the basis of B-mode sonography and colour Doppler 20% patients were diagnosed to have acute deep vein thrombosis and 12 % patients were diagnosed to have chronic deep vein thrombosis. Out of 100 chronic bedridden patients in the study, 40% were suspected to have deep vein thrombosis on the basis of clinical signs,45% had a positive d-dimer test, 28% were positive on impedence plethysmography.  30% patients were diagnosed to have deep vein thrombosis by B mode sonography and 32% were diagnosed to have deep vein thrombosis by colour Doppler. Conclusion: Only 32 patients were positive for deep vein thrombosis out of 100 patients so it is safe to withhold unnecessary anticoagulation therapy in all chronic bed   ridden patients because even after 3 month follow up only 1% patients were positive. Impedence plethysmography is less sensitive than ultrasonography and D-dimer test is more sensitive but it lacks specificity so ultrasound and colour Doppler is more sensitive in clinically suspected DVT patients. Ultrasonography and colour Doppler is better predictor of DVT because it is more sensitive and specific, non-invasive, painless, widely available, easy to use, less expensive, no ionizing radiation. Keywords: antithrombotic, pulmonary &embolism.

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