scholarly journals Venous thromboembolism in patients with heart failure

2011 ◽  
Vol 10 (4) ◽  
pp. 101-106 ◽  
Author(s):  
O. V. Averkov ◽  
I. V. Shevchenko ◽  
T. Sh. Mirilashvili ◽  
Zh. D. Kobalava
Keyword(s):  
Heart Failure ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Comparative Effectiveness ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Patients With Heart Failure ◽  
Clinical Potential

This review is focussed on the problem of venous thromboembolism in patients with heart failure (HF). The results of the major clinical trials of antithrombotic therapy in HF patients are presented. The authors discuss comparative effectiveness, safety, and tolerability of unfractionated heparins, low molecular weight heparins, and fondaparinux. The results of the two trials, MAGELLAN and ADOPT, are expected to clarify the clinical potential of such oral anticoagulants as rivaroxaban and apixaban (Factor Xa inhibitors). The problem of low rates e of preventive antithrombotic administration is emphasized.

Safety and efficacy of direct oral anticoagulants for venous thromboembolism and stroke prophylaxis in patients with hematologic malignancies

2019 ◽  
Vol 26 (2) ◽  
pp. 351-360 ◽  
Author(s):  
Stephanie Kim ◽  
Jennifer Namba ◽  
Aaron M Goodman ◽  
Thi Nguyen ◽  
Ila M Saunders
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Hematologic Malignancies ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Low Molecular Weight Heparins ◽  
Bleeding Events

Purpose Low-molecular-weight heparins are currently the recommended antithrombotic therapy for treatment and prevention of malignancy-related venous thromboembolism. Currently, the evidence evaluating direct oral anticoagulants versus low-molecular-weight heparins or a vitamin K antagonist in cancer patients with hematologic malignancies is limited. We evaluated the safety and efficacy of direct oral anticoagulants for venous thromboembolism treatment or stroke prevention for non-valvular atrial fibrillation in patients with hematologic malignancies. Methods This was a retrospective evaluation of adult patients with hematologic malignancies who received at least one dose of the Food and Drug Administration-approved direct oral anticoagulant for venous thromboembolism treatment or stroke prevention. We determined the frequency of major bleeding events, non-major bleeding events, stroke, systemic embolism, appropriateness of initial direct oral anticoagulant doses, holding practices prior to procedures, and the rate of all-cause mortality. An analysis was also performed to compare the incidence of bleeding between patients with a history of hematopoietic stem cell transplant to non-transplant patients. Results A total of 103 patients were identified, with the majority of patients receiving rivaroxaban for venous thromboembolism treatment. Major bleeding events occurred in four patients and no fatal bleeding events occurred. Non-major bleeding occurred in 29 patients, most commonly epistaxis and bruising. Two patients experienced a systemic embolism while on direct oral anticoagulant therapy. Conclusion Direct oral anticoagulants may be a safe and effective alternative for anticoagulation therapy in patients with hematologic malignancies. However, larger prospective studies comparing direct oral anticoagulants to low-molecular-weight heparins or vitamin K antagonists are warranted to compare efficacy and safety outcomes in this patient population.

scholarly journals What is the Best Treatment for a Cancer Patient with Thrombosis?

2014 ◽  
Vol 8 ◽  
pp. CMO.S13386 ◽  
Author(s):  
Miguel Barbosa
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Cancer Patient ◽  
Scientific Evidence ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Adequate Treatment ◽  
The Relationship

The relationship between venous thromboembolism and cancer has been known for many years, and there is solid scientific evidence addressing the adequate treatment of this condition in oncology patients. However, established prescribing habits, individual patient challenges, and uncertainty concerning treatment justifies poor adherence to published guidelines. This paper reviews venous thromboembolism treatment while focusing on vitamin K antagonists, low-molecular-weight heparins, and novel oral anticoagulants, namely in terms of their efficacy and limitations.

The Role of Low Molecular Weight Heparins for Venous Thromboembolism Prevention in Medical Patients—What Is New in 2019?

2019 ◽  
Vol 39 (01) ◽  
pp. 062-066 ◽  
Author(s):  
Sylvia Haas
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Randomized Clinical Trials ◽  
Scientific Evidence ◽  
Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Low Molecular Weight Heparins ◽  
Venous Thromboembolism Prevention ◽  
Extended Duration

AbstractLow molecular weight heparins and fondaparinux have been the cornerstones for prevention of venous thromboembolism (VTE) in acutely ill medical patients for almost two decades. Guidelines recommend the use of these parenteral anticoagulants for 6 to 14 days but advise against extended-duration thromboprophylaxis after hospital discharge because no compelling scientific evidence has been provided for pharmacological prophylaxis beyond hospital stay. Five large randomized clinical trials, one with low molecular weight heparin and four with nonvitamin K antagonist oral anticoagulants, have failed to show significant clinically relevant benefit in this indication. Obviously, the development of VTE is more complex in medical patients than in patients undergoing major surgical procedures. Thus, it can be expected that guideline recommendations for VTE prevention with low molecular weight heparins or fondaparinux in medical patients will remain unchanged in 2019.

Retrospective comparison of low molecular weight heparin vs. warfarin vs. oral Xa inhibitors for the prevention of recurrent venous thromboembolism in oncology patients: The Re-CLOT study

2017 ◽  
Vol 24 (7) ◽  
pp. 494-500 ◽  
Author(s):  
Saeed K Alzghari ◽  
Susan E Seago ◽  
Jessica E Garza ◽  
Yasmeen F Hashimie ◽  
Kimberly A Baty ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Factor Xa ◽  
Factor Xa Inhibitors ◽  
First Episode ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Oncology Patients ◽  
Recurrent Venous Thromboembolism

Background There is increasing evidence indicating oral factor Xa inhibitors can be used for secondary prevention of venous thromboembolism. Studies are needed to compare oral factor Xa inhibitors, low molecular weight heparins, and warfarin in the oncology population. The purpose of this study is to evaluate the recurrent venous thromboembolism incidence in oncology patients utilizing oral Xa inhibitors, low molecular weight heparins, or warfarin. Methods Using retrospectively collected data, we compared the recurrent venous thromboembolism incidence in oncology patients taking rivaroxaban/apixaban, enoxaparin, or warfarin with at least three months of follow-up. Patients were included if they had an active cancer, venous thromboembolism, and taking warfarin, enoxaparin, or rivaroxaban/apixaban. The primary endpoint was the first episode of recurrent venous thromboembolism at three months. Secondary endpoints included recurrent venous thromboembolism after six months, major bleeding, and mortality. Results Of 127 venous thromboembolism patients, 48 received rivaroxaban or apixaban, 23 received enoxaparin, and 56 received warfarin. The three most common cancer diagnoses were lung (21%), colorectal (14%), and breast (14%). There was no difference in venous thromboembolism recurrence at three months between the rivaroxaban/apixaban (0%), warfarin (3.6%), and the enoxaparin cohorts (4.4%) (p = 0.8319). Major bleeding at three months was only seen in one patient in the enoxaparin arm (4.2%). Mortality at three months was 0%, 3.6%, and 17.4% in the rivaroxaban/apixaban, warfarin, and enoxaparin cohorts, respectively. Conclusion The results of this retrospective study suggest that oral factor Xa inhibitors are potential options for cancer patients with venous thromboembolism. However, randomized, controlled trials are needed to confirm these results.

Cost-effectiveness of apixaban versus other direct oral anticoagulants and low-molecular-weight-heparins for cancer associated venous thromboembolism in Spain.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18845-e18845
Author(s):  
Andres J. Muñoz Martín ◽  
Enrique Gallardo Díaz ◽  
Carlos Crespo ◽  
Roma Masana Domenech ◽  
Javier Soto ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Relative Effectiveness ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Use Of Resources ◽  
Life Years

e18845 Background: Venous thromboembolism (VTE) causes substantial morbidity and mortality in patients with cancer. The guidelines for the treatment of VTE in cancer patients recommend low molecular weight heparins (LMWH) and direct oral anticoagulants (DOAC) for patients where major bleeding is a low risk factor. Several studies show that DOAC represent a convenient and effective treatment option in alternative to LMWH in patients with deep-vein thrombosis or pulmonary embolism. Even though some recent studies have compared the effectiveness of DOAC vs LMWH, there is no available a cost-effectiveness analysis (CEA) comparing the relative effectiveness and cost-effectiveness of apixaban, other DOAC and. LMWH. The study aim was to conduct a CEA of apixaban (API), edoxaban (EDO), rivaroxaban (RIVA) and LMWH for the treatment of cancer associated VTE in Spain. Methods: We developed a Markov model with 12 transition health states. The model has been face-validated by two oncologists from two different Spanish hospitals. The use of resources and costs were obtained from the 2021 Spanish Ministry of Health database, and the main references for obtaining the outcomes were derived from CARAVAGGIO, HOKUSAI-VTE, ADAM VTE and SELECT-D trials. Our model yielded the effectiveness score in terms of cost per life-year (LY) gained and cost per quality-adjusted for life-year (QALY) gained. The time horizon was 12 months. We performed a deterministic and probabilistic sensitivity analysis to validate the robustness. Results: API showed the lowest 12-month cost (1943 €), and the highest amount of life years (0.79) and highest amount of QALY (0.55) gained. RIVA and EDO were less effective in terms of LY (0.76 and 0.74, respectively) and QALY (0.53 and 0.52, respectively) gained than LMWH (LY of 0.76 and QALY of 0.53), and less costly. The Incremental Cost-Effectiveness Ratio (ICER) scores in terms both of €/LY and €/QALY gained show that API is dominant over LMWH, RIVA and EDO. Conclusions: Our results suggest that API is more effective and more cost-effective than LMWH, RIVA or EDO with the 2021 Spanish healthcare costs. For interpretation of the results, reader must consider that the costs of resources analyzed in this paper may vary from country to country, and dabigatran was not included in the analysis since there are not cancer associated VTE clinical trials with dabigatran data to calculate CEA from.[Table: see text]

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