Deep Venous Thrombosis

2019 ◽  
Author(s):  
Boaz Zadok Weiss ◽  
Evan Avraham Alpert
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Current Trend ◽  
Clinical Work ◽  
Medical Problem ◽  
Postthrombotic Syndrome ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis ◽  
D Dimer

In a patient with DVT, a clot forms in the large veins of the extremities, typically the leg, which can lead to a pulmonary embolus, a potentially life-threatening medical problem. Risk factors include provoking factors such as recent surgery, acquired factors such as obesity or cardiovascular disease, and genetic factors such as protein C or S deficiency. The Wells DVT score is a clinical scoring system that allows the assessment of the pretest probability of DVT. However, clinical gestalt has been found to be equally accurate. This can then guide the clinical work-up of the patient, with low and moderate pretest probabilities, allowing one to start with D-dimer testing, versus high probability, requiring one to begin with lower extremity US. The current trend in treatment of DVT is the novel oral anticoagulants as they can be given at fixed doses, do not require laboratory monitoring, and have a better safety profile than warfarin. Pregnant patients, those with cancer, as well as many with recurrent DVT are treated with low-molecular-weight heparin. Most patients with DVT may be treated as an outpatient. A small percentage of patients with severe DVT may benefit from catheter-directed thrombolysis.  This review contains 1 figures, 2 tables, and 48 references. Key Words: anticoagulants, D-dimer, diagnostic ultrasonography, DVT, low molecular weight heparin, postthrombotic syndrome, unfractionated heparin, warfarin

Deep Venous Thrombosis

2019 ◽  
Author(s):  
Boaz Zadok Weiss ◽  
Evan Avraham Alpert
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Current Trend ◽  
Clinical Work ◽  
Medical Problem ◽  
Postthrombotic Syndrome ◽  
Low Molecular Weight ◽  
Catheter Directed Thrombolysis ◽  
D Dimer

In a patient with DVT, a clot forms in the large veins of the extremities, typically the leg, which can lead to a pulmonary embolus, a potentially life-threatening medical problem. Risk factors include provoking factors such as recent surgery, acquired factors such as obesity or cardiovascular disease, and genetic factors such as protein C or S deficiency. The Wells DVT score is a clinical scoring system that allows the assessment of the pretest probability of DVT. However, clinical gestalt has been found to be equally accurate. This can then guide the clinical work-up of the patient, with low and moderate pretest probabilities, allowing one to start with D-dimer testing, versus high probability, requiring one to begin with lower extremity US. The current trend in treatment of DVT is the novel oral anticoagulants as they can be given at fixed doses, do not require laboratory monitoring, and have a better safety profile than warfarin. Pregnant patients, those with cancer, as well as many with recurrent DVT are treated with low-molecular-weight heparin. Most patients with DVT may be treated as an outpatient. A small percentage of patients with severe DVT may benefit from catheter-directed thrombolysis.  This review contains 1 figures, 2 tables, and 48 references. Key Words: anticoagulants, D-dimer, diagnostic ultrasonography, DVT, low molecular weight heparin, postthrombotic syndrome, unfractionated heparin, warfarin

Antithrombotic Therapy for DVT/PE

1997 ◽  
Vol 17 (03) ◽  
pp. 161-162
Author(s):  
Thomas Hyers
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Therapeutic Agents ◽  
Great Promise ◽  
Term Therapy ◽  
Low Molecular Weight ◽  
Long Term Therapy

SummaryProblems with unfractionated heparin as an antithrombotic have led to the development of new therapeutic agents. Of these, low molecular weight heparin shows great promise and has led to out-patient therapy of DVT/PE in selected patients. Oral anticoagulants remain the choice for long-term therapy. More cost-effective ways to give oral anticoagulants are needed.

scholarly journals Safety and efficacy of direct oral anticoagulants (DOACs) vs low molecular weight heparin (LMWH) in malignancy induced venous thromboembolism-a systematic review and meta analysis

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
N Hussain ◽  
S Adeel Hassan ◽  
S Mandava ◽  
F Yasmin ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Dichotomous Data ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background- Low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) have been proven to be more effective in the management of venous thromboembolism (MVTE). The efficacy and safety of LMWH or DOACs in treatment of recurrent or malignancy induced VTE is not studied in literature. Objective To compare the efficacy and safety of LMWH and  DOACs in the management of malignancy induced  VTE Methods- Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to November  28th, 2020. Dichotomous data was extracted for prevention of VTE and risk of major bleeding in patients taking either LMWH or DOACs. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.  Results- Three studies with 2607 patients (DOACs n = 1301 ; LMWH n = 1306) were included in analysis. All the study population had active cancer of any kind diagnosed within the past 6 months. Average follow-up period for each trial was 6 months. Patients receiving DOACs have a lower odds of recurrence of MVTE as compared to LMWH( OR 1.56; 95% CI 1.17-2.09; P = 0.003, I2 = 0). There was no significant difference in major bleeding among patients receiving LMWH or DOACs  (OR-0.71, 95%CI 0.46-1.10, P = 0.13, I2 = 22%) (Figure 1). We had no publication bias in our results (Egger’s regression p > 0.05). Conclusion- DOACs are superior to LMWH in prevention of MVTE and have similar major bleeding risk as that of LMWH. Abstract Figure. A)VTE Recurrence B)Major Bleeding events

A single center retrospective cohort study comparing low-molecular-weight heparins to direct oral anticoagulants for the treatment of venous thromboembolism in patients with cancer – A real world experience

2018 ◽  
Vol 25 (4) ◽  
pp. 793-800 ◽  
Author(s):  
Megan K Phelps ◽  
Tracy E Wiczer ◽  
H Paige Erdeljac ◽  
Kelsey R Van Deusen ◽  
Kyle Porter ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Direct Oral Anticoagulant ◽  
Recurrent Cancer ◽  
Cancer Associated Thrombosis

Introduction Low-molecular-weight heparins are the standard treatment for cancer-associated thrombosis. Recently, direct oral anticoagulants are a new option for thrombosis treatment; however, data supporting the use of direct oral anticoagulants for cancer-associated thrombosis are limited. Objectives The primary objective of this study was to determine the rate of recurrent cancer-associated thrombosis and major bleeding within 6 months of starting either low-molecular-weight heparin or direct oral anticoagulant for treatment of cancer-associated thrombosis. Secondary objectives were to determine the rates of clinically relevant-non-major bleeding and all-cause mortality. Patients/methods This is a retrospective cohort study including adults with cancer-associated thrombosis treated with low-molecular-weight heparin or direct oral anticoagulant between 2010 and 2016 at the Ohio State University. Medical records were reviewed for 6 months after initiation of anticoagulation or until the occurrence of recurrent cancer-associated thrombosis, major bleeding, cessation of anticoagulation of interest, or death, whichever occurred first. Results Four hundred and eighty patients were included (290 low-molecular-weight heparin and 190 direct oral anticoagulant). Patients treated with direct oral anticoagulant were found to carry “lower risk” features including cancer with lower VTE risk and lower rate of metastatic disease. After adjustment for baseline differences, there was no significant difference in the rate of recurrent cancer-associated thrombosis (7.2% low-molecular-weight heparin vs 6.3% direct oral anticoagulant, p = 0.71) or major bleeding (7.6% low-molecular-weight heparin vs 2.6% direct oral anticoagulant, p = 0.08). Conclusions Our study demonstrates that in a select population of cancer patients with VTE, direct oral anticoagulant use can be as effective and safe compared to the standard therapy with low-molecular-weight heparin.

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