Anticoagulation Treatment in Venous Thromboembolism: Options and Optimal Duration

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites). This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽

10.1182/blood.v106.11.584.584 ◽

2005 ◽

Vol 106 (11) ◽

pp. 584-584

Author(s):

Frederick A. Spencer3 ◽

Robert J. Goldberg ◽

Darleen Lessard ◽

Cathy Emery ◽

Apar Bains ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Central Venous Catheter ◽

Lower Extremity ◽

Upper Extremity ◽

Venous Catheter ◽

Central Venous ◽

Vein Thrombosis ◽

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

New anticoagulants for the treatment of venous thromboembolism

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016042020068 ◽

2016 ◽

Vol 42 (2) ◽

pp. 146-154 ◽

Cited By ~ 13

Author(s):

Caio Julio Cesar dos Santos Fernandes ◽

José Leonidas Alves Júnior ◽

Francisca Gavilanes ◽

Luis Felipe Prada ◽

Luciana Kato Morinaga ◽

...

Keyword(s):

Venous Thromboembolism ◽

Vitamin K Antagonists ◽

Factor Xa ◽

Thrombin Inhibitors ◽

Direct Thrombin Inhibitors ◽

Vein Thrombosis ◽

New Anticoagulants ◽

Acute Pulmonary Thromboembolism ◽

Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context.

Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review

Journal of Neurosurgery ◽

10.3171/jns.1984.61.6.1055 ◽

1984 ◽

Vol 61 (6) ◽

pp. 1055-1062 ◽

Cited By ~ 68

Author(s):

Karl W. Swann ◽

Peter McL. Black

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Anticoagulation Therapy ◽

Screening Tests ◽

Limb Weakness ◽

Prophylactic Measure ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Neurosurgical Patients ◽

✓ This review examines the incidence, natural history, diagnosis, prophylaxis, and management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients. Recent studies estimate the incidence of postoperative DVT detected by fibrinogen scanning in neurosurgical patients to be 29% to 43%. Specific factors that enhance the risk of venous thromboembolism include previous DVT, surgery, immobilization, advanced age, obesity, limb weakness, heart failure, and lower extremity trauma. Clinical diagnosis of venous thromboembolism is unreliable but can be augmented by noninvasive screening tests such as iodine-125-fibrinogen scanning, Doppler ultrasonography, and impedance plethysmography. As prophylactic measures, mini-dose heparin and external pneumatic compression of the legs have decreased the incidence of DVT in clinical studies of neurosurgical patients. However, no prophylactic measure has been convincingly shown to prevent PE in neurosurgical patients. Thrombi involving the popliteal, deep femoral, and iliac veins appear most likely to cause significant PE. Anticoagulation therapy constitutes standard management of DVT and PE; however, in neurosurgical patients the potential for precipitating intracranial or intraspinal hemorrhage may necessitate vena caval interruption. This appears to be an effective alternative to anticoagulation.

Factors affecting the recurrence in patients with venous thromboembolism: A retrospective cohort study

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2021.20679 ◽

2021 ◽

Vol 29 (3) ◽

pp. 384-390

Author(s):

Yasemin Ateş ◽

Züleyha Bingöl ◽

Gülfer Okumuş ◽

Orhan Arseven

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Pulmonary Thromboembolism ◽

First Year ◽

Factors Affecting ◽

Vein Thrombosis ◽

Hereditary Risk ◽

Deep Vein ◽

D Dimer

Background: The aim of the study was to evaluate the frequency of recurrence and the risk factors for recurrence in patients who were diagnosed with venous thromboembolism. Methods: Between January 2005 and January 2015, a total of 412 venous thromboembolism patients (164 males, 248 females; mean age: 53.5±16.6 years; range: 19 to 95 years) were retrospectively analyzed. The demographics, underlying risk factors, comorbidities, imaging findings, and treatment data of the patients were recorded. Results: At least one transient/permanent risk factor was found in 341 (82.7%) of the index events, and the other 71 (17.2%) were idiopathic. Recurrence developed in 76 (18.4%) of the patients. The duration of the treatment in the first event was significantly longer in recurrent cases (p=0.007). The recurrence rate in patients diagnosed with only deep vein thrombosis or patients diagnosed with pulmonary thromboembolism + deep vein thrombosis was significantly higher than the patients diagnosed with only pulmonary thromboembolism (24% vs. 14.2%, respectively; p=0.007). The rate of idiopathic venous thromboembolism was higher in recurrent cases than in non-recurrent cases (26.3% vs. 15.2%, respectively; p=0.028). At the end of the first year, the mean D-dimer levels were higher in recurrent cases (p=0.034). Hereditary risk factors were also higher in recurrent cases (39.5% vs. 19.3%, respectively; p=0.031). There was no significant correlation between recurrence and mortality. Conclusion: The presence of deep vein thrombosis, idiopathic events, high D-dimer levels at the end of the first year and hereditary risk factors seem to be associated with recurrence.

Deep Vein Thrombosis and Venous Thromboembolism in the Critically Ill

10.2310/7ccsp.8344 ◽

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 ◽

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

Venous Thromboembolism

10.2310/7900.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites). This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

D-Dimer Level Significance for Deep Vein Thrombosis Screening in The Third Trimester : A Retrospective Study

10.21203/rs.3.rs-753804/v1 ◽

2021 ◽

Author(s):

Keisuke Miyamoto ◽

Hiroaki Komatsu ◽

Masayo Okawa ◽

Yuki Iida ◽

Daiken Osaku ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Lower Limb ◽

Third Trimester ◽

Vein Thrombosis ◽

The Third ◽

Deep Vein ◽

D Dimer ◽

Compression Ultrasonography

Abstract BackgroundVenous thromboembolism often develops after surgery and childbirth, resulting in death in some cases. Although early deep vein thrombosis (DVT) detection can predict pulmonary thromboembolism, there is no early screening method for DVT in pregnant women. Lack of consensus regarding significance or setting and cut-off value interpretation of D-dimer levels further impedes venous thromboembolism screening in pregnant women.This study aimed to examine the utility of third-trimester serum D-dimer levels for screening test for DVT during pregnancy.to determine the frequency of asymptomatic DVT using lower-limb compression ultrasonography.MethodsThis single-center retrospective study included 497 pregnant women who underwent elective cesarean section at term in our hospital between January 2013 and December 2019. Serum D-dimer levels were preoperatively measured at 32–37 gestation weeks. The presence or absence of DVT in patients with serum D-dimer levels ≥ 3.0 µg/ml, the cut-off value, was examined using compression ultrasonography. In all patients, the presence or absence of clinical venous thrombosis (symptoms such as lower-limb pain, swelling, and heat sensation) was examined within 4 postoperative weeks.The Royal College of Obstetricians and Gynecologists Guideline 2015 was referred to determine risk factors for the onset of venous thrombosis during pregnancy. Among those, we examined the risk factors for DVT that result in high D-dimer levels during pregnancy.ResultsThe median age and body mass index were 35 (20–47) years and 21.2 (16.4–41.1) kg/m2, respectively. Further, the median gestational age and D-dimer levels were 37 weeks and 2.1 (0.2–16.0) µg/ml, respectively. Compression ultrasonography was performed on 135 (26.5%) patients with a D-dimer level ≥3.0 µg/ml, with none of the patients showing DVT. All patients were followed up for 4 postoperative weeks, with none presenting with venous thromboembolism. Multivariate analysis showed that hypertensive disorders of pregnancy is an independent risk factor for venous thromboembolism that causes high D-dimer levels (odds ratio: 2.48, 95% confidence interval: 1.05–6.50, P=0.04).ConclusionThere may be low utility in screening for DVT using D-dimer levels in the third trimester. Further, prepartum asymptomatic DVT has a low frequency, indicating the low utility of compression ultrasonography.Trial registrationInstitutional Review Board of Tottori University Hospital (IRB no. 20A149).

Venous Thromboembolism

10.2310/neuro.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites). This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Strategies for Diagnosis and Prevention of Venous Thromboembolism during Pregnancy

Journal of Pregnancy ◽

10.1155/2011/206858 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Shalini Jain Bagaria ◽

V. B. Bagaria

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Adverse Effects ◽

Risk Stratification ◽

Postpartum Period ◽

Vein Thrombosis ◽

Altered Physiology ◽

Deep Vein ◽

Pregnancy and the postpartum period have an increased incidence of venous thromboembolism (VTE). The condition is unique during this period for several reasons. Primarily, because there is complexity in diagnosing this condition in view of altered physiology and preexisting edema in pregnancy and also because there are restrictions on the use of certain drugs and a need for vigilant monitoring of anticoagulant activities of drugs during the period. The problem is compounded and assumes the highest order of significance since two lives are involved and all the investigations and management done should also take into account the potential adverse effects on the foetus. In order to prevent the development of VTE during pregnancy, sound clinical evaluation for risk factors, risk stratification, and optimal use of resource both mechanical and pharmacological is necessary. This paper details strategies in preventing development of deep vein thrombosis and treatment of VTEs.