scholarly journals HOW NEW APPROACHES TO THE TREATMENT OF PULMONARY EMBOLISM AFFECT THE OUTCOME OF THE DISEASE?

2017 ◽  
pp. 48-55
Author(s):  
M. Y. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Diagnostic Techniques ◽  
New Approach ◽  
Vein Thrombosis ◽  
Improved Outcomes ◽  
Venous Thromboembolic ◽  
Deep Vein ◽  
Effective Drugs

Pulmonary embolism (PE) is the key potentially reversible cause of in-hospital mortality. To help the practitioner, leading experts in different countries are developing and updating guidelines which analyze and generalize approaches to the treatment of PE. Recently, among the factors leading to positive dynamics in outcomes of patients with PE (according to the RIETE registry),the researchers have considered improvement of diagnostic techniques as well as technical improvements in tomographic scanners. Another reason for improved outcomes of treated patients with deep vein thrombosis and pulmonary embolism is optimization of anticoagulation therapy. The emergence of “new” oral anticoagulants (NOAC: rivaroxaban, dabigatran, apixaban) marked the beginning of a qualitatively new approach to the treatment of PE characterized by convenience of treatment without the need for regular monitoring of blood coagulation parameters. In addition to the emergence of new convenient and effective drugs, the approach to diagnosis and treatment of patients also changed, as reflected in the updated guidelines for the management of patients with venous thromboembolic complications (ESC 2014, ACCP 2016).

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  

scholarly journals ORAL ANTICOAGULANTS IN THE TREATMENT OF VENOUS THROMBOEMBOLIC COMPLICATIONS: FOCUS ON APIXABAN

2017 ◽  
pp. 56-62 ◽  
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Vitamin K Antagonist ◽  
Fixed Dose ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Deep Vein

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

High incidence of in-hospital pulmonary embolism following joint arthroplasty with dalteparin prophylaxis

2010 ◽  
Vol 103 (01) ◽  
pp. 123-128 ◽  
Author(s):  
Jason Kerr ◽  
Lori-Ann Linkins
Keyword(s):  
Pulmonary Embolism ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Joint Arthroplasty ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

SummaryThe in-hospital incidence of pulmonary embolism (PE) in patients undergoing elective joint arthroplasty who receive a minimum of 10 days of dalteparin prophylaxis is reported to be less than 1%. Recent clinical experience raised suspicion that the incidence of PE was significantly higher at our tertiary care institution. It was the objective of this study to determine the incidence of in-hospital PE and symptomatic deep-vein thrombosis following elective joint arthroplasty in patients who received a minimum of 10 days of dalteparin prophylaxis. Consecutive charts of patients who underwent elective joint arthroplasty at our institution between January 2008 and June 2008 were reviewed. Data on risk factors for venous thromboembolism, objectively documented venous thromboembolic events, and signs and symptoms of PE were abstracted. Patients who received concomitant warfarin in the postoperative period were excluded. The study population consisted of 437 knee arthroplasty and 246 hip arthroplasty patients. The incidence of in-hospital PE following knee arthroplasty and hip arthroplasty was 4.6% and 0.4%, respectively. One out of every 10 knee patients, and one out of every 20 hip patients underwent testing for pulmonary embolism. Pulmonary embolism was diagnosed a median of 3.5 days after knee arthroplasty. The incidence of in-hospital PE in knee arthroplasty patients who received dalteparin prophylaxis was significantly higher than expected. Potential explanations for this finding include poor efficacy of dalteparin started 12–24 hours postoperatively and/or a low threshold for ordering diagnostic imaging for PE. Studies to clarify these issues are needed.

Heparins and Venous Thromboembolism: Current Practice and Future Directions

2001 ◽  
Vol 86 (07) ◽  
pp. 488-498 ◽  
Author(s):  
Paolo Prandoni
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Outpatient Setting ◽  
Vein Thrombosis ◽  
Treatment And Prevention ◽  
Major Orthopedic Surgery ◽  
Venous Thromboembolic ◽  
Reduction Of Mortality ◽  
Deep Vein

SummaryUnfractionated heparin (UFH) in adjusted doses and low-molecularweight heparins (LMWH) in fixed doses are the chosen therapy for the initial treatment of venous thromboembolism. The use of UFH protocols ensures that virtually all patients will promptly achieve the therapeutic range for the activated partial thromboplastin time. However, proper use of UFH requires considerable expertise, can cause inconvenience and has limitations. Unmonitored therapy with subcutaneous LMWH is at least as effective and safe as adjusted-dose UFH, is associated with a considerable reduction of mortality in cancer patients, and permits the treatment of suitable patients in an outpatient setting.LMWH in high prophylactic doses is more effective than UFH and oral anticoagulants for prevention of postoperative venous thrombosis in major orthopedic surgery. Whether thromboprophylaxis should be continued for a few additional weeks after hospital discharge is controversial. LMWH and UFH are equally effective for prevention of postoperative deep-vein thrombosis in cancer patients. In a recent controlled randomized trial, enoxaparin in high prophylactic doses was an effective and safe measure of thromboprophylaxis in ordinary bedridden patients.The efficacy and safety of pentasaccharide (the smallest antithrombin binding sequence of heparin) in the treatment and prevention of venous thromboembolic disorders is currently under investigation.

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 Description of selected diagnostic tools in assessing the risk of venous thromboembolic disease

2016 ◽  
Vol 15 (1) ◽  
pp. 5-8
Author(s):  
Renata Piotrkowska ◽  
Piotr Jarzynkowski ◽  
Janina Książek
Keyword(s):  
Pulmonary Embolism ◽  
World Literature ◽  
Common Factor ◽  
Medical Problem ◽  
Thromboembolic Disease ◽  
Diagnostic Tools ◽  
Venous Thromboembolic Disease ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Deep Vein

AbstractIntroduction. Deep vein thrombosis (DVT) and its most severe complication, pulmonary embolism (PE) is an interdisciplinary medical problem. Despite a wealth of knowledge, pulmonary embolism is the cause of about 10% of deaths among hospitalized patients and the most common factor which can be prevented. Therefore correct, rapid diagnosis of the patient’s assessment of the risk of sudden death and the quick implementation of treatment are essential to reduce mortality in this disease and prevent its distant complications.Aim of the study. The aim of this paper is to discuss on the basis of Polish and world literature the selected diagnostic tools in assessing the risk of venous thromboembolic disease.

scholarly journals Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association?

2019 ◽  
Vol 8 (6) ◽  
pp. 899 ◽  
Author(s):  
Elena-Mihaela Cordeanu ◽  
Hélène Lambach ◽  
Marie Heitz ◽  
Julie Di Cesare ◽  
Corina Mirea ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Prognostic Significance ◽  
Vein Thrombosis ◽  
All Cause Mortality ◽  
Deep Vein ◽  
The Impact

Background: The prognostic significance of coexisting deep vein thrombosis (DVT) in acute pulmonary embolism (PE) is controversial. This study aimed to provide routine patient care data on the impact of this association on PE severity and 3-month outcomes in a population presenting with symptomatic venous thromboembolism (VTE) from the REMOTEV registry. Methods and Results: REMOTEV is a prospective, non-interventional study of patients with acute symptomatic VTE, treated with direct oral anticoagulants (DOACs) or standard anticoagulation (vitamin K antagonists (VKA) or parenteral heparin/fondaparinux alone) for at least 3 months. From 1 November 2013 to 28 February 2018, among 1241 consecutive patients included, 1192 had a follow-up of at least 3 months and, among them, 1037 had PE with (727) or without DVT (310). The median age was 69 (55–80, 25th–75th percentiles). Patients with PE-associated DVT had more severe forms of PE (p < 0.0001) and, when DVT was present, proximal location was significantly correlated to PE severity (p < 0.01). However, no difference in all-cause mortality rate (hazard ratio (HR) 1.36 (CI 95% 0.69–2.92)), nor in the composite criterion of all-cause mortality and recurrence rate (HR 1.56 (CI 95% 0.83–3.10)) was noted at 3 months of follow-up. Conclusion: In REMOTEV, coexisting DVT was associated with a higher severity of PE, with no impact on short-term prognosis.

scholarly journals Safety and feasibility of rivaroxaban in deferred workup of patients with suspected deep vein thrombosis

2020 ◽  
Vol 4 (11) ◽  
pp. 2468-2476
Author(s):  
Synne G. Fronas ◽  
Anders E. A. Dahm ◽  
Hilde S. Wik ◽  
Camilla T. Jørgensen ◽  
Jostein Gleditsch ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Secondary Outcome ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Therapeutic Doses ◽  
Deep Vein

Abstract Guidelines suggest using empiric low-molecular-weight heparin if the diagnostic workup of deep vein thrombosis (DVT) is expected to be delayed. The role of direct oral anticoagulants for deferred compression ultrasound imaging (CUS) in patients with suspected DVT remains unexplored. The main objective of the study was to assess the safety of deferring CUS with therapeutic doses of rivaroxaban. We prospectively included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected first or recurrent lower-extremity DVT between February 2015 and November 2018. Patients were discharged with rivaroxaban 15 mg twice daily while awaiting CUS within 24 hours if D-dimer level was ≥0.5 mg/L fibrinogen-equivalent units. The primary outcome was the rate of major bleeding incidents from study inclusion until DVT was confirmed and anticoagulation therapy continued, or otherwise up to 48 hours following administration of the last tablet of rivaroxaban. The secondary outcome was the rate of progressive DVT symptoms or symptoms or signs of pulmonary embolism between hospital discharge until venous thromboembolism was diagnosed. Six hundred twenty-four of 1653 patients referred with suspected DVT were included (37.7%; 95% confidence interval [CI], 35.4-40.1). DVT was diagnosed in 119 patients (19.1%; 95% CI, 16.1-22.3). There were no major bleeding incidents, yielding an observed major bleeding rate of 0% (1-sided 95% CI &lt;0.4). No patients experienced major complications in the interval that CUS was deferred (0%; 95% CI, 0.0-0.6). Deferring CUS for up to 24 hours in patients with suspected DVT with therapeutic doses of rivaroxaban is a safe strategy. This trial was registered at www.clinicaltrials.gov as #NCT02486445.

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