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Long-term Effect of Chronic Oral Anticoagulation with Warfarin after Acute Myocardial Infarction
As compared with placebo or aspirin, OAC with or without aspirin does not reduce mortality or reinfarction, reduces stroke, but is associated with significantly more major bleeding.
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Increased Rate of Stent Thrombosis and Target Lesion Revascularization After Filter Protection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
The purpose of this study was to evaluate the long-term effects of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
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Family History of Venous Thromboembolism and Identifying Factor V Leiden Carriers During Pregnancy
Although a family history of venous thromboembolism is associated with factor V Leiden mutation in thrombosis-free gravid women, the sensitivity and positive predictive values are too low to recommend screening women for the factor V Leiden mutation based solely on a family history.
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When Should an IVC Filter Be Used to Treat a DVT?
An IVC filter should be considered in patients with a DVT who have a contraindication to anticoagulation. Other indications for IVC filter use are not supported by the current literature.
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Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial
Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.
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Every Five Minutes Someone Dies from a Blood Clot
More than 17,000 Americans have already died in 2010 from blood clots in the lungs. The Vascular Disease Foundation’s Venous Disease Coalition, reminds us of this sobering fact on its homepage with a new counting widget at www.venousdiseasecoalition.org, and urges Americans to learn the risks of venous blood clots to help prevent these deaths.
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DVT: A New Era in Anticoagulant Therapy
March is deep vein thrombosis awareness month in the United States. To mark this event, this issue of Arteriosclerosis, Thrombosis, and Vascular Biology contains a series of reviews on new anticoagulants that either are in development or have been approved for clinical use. Particularly exciting are the new oral inhibitors of thrombin (dabigatran etexilate) and factor Xa (rivaroxaban).
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Increased Risk of Thromboembolism 12 Weeks After Surgery
"These findings suggest that the risk of venous thromboembolism after surgery is greater and lasts for longer than previously thought," the authors wrote. "Overall, we found increased relative risks of venous thromboembolism during the [first] 17 postoperative weeks that were much larger than those reported previously."
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Aspirin and clopidogrel resistance: methodological challenges and opportunities
Antiplatelet drug resistance is one of the urgent issues in current cardiovascular medicine. Many platelet function tests have been used to define responsiveness of patients with cardiovascular disease to aspirin and clopidogrel.
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VTE Preventive Therapy Reduces Costs, But Adherence Is Often Lacking
Less than half of patients who were at risk of venous thromboembolism (VTE) received pharmacological prophylaxis during hospitalization, and less than 10% received postdischarge medication to prevent VTE, according to the results of a data analysis reported at Chest 2009. In a related study presented at the same meeting, lead author Alpesh N. Amin, MD, MBA, and colleagues also reported that inadequate VTE prophylaxis resulted in longer hospital stays and increased costs.
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Modern role for clopidogrel in management of atrial fibrillation and stroke reduction
Treatment regimens for preventing thromboembolism in AF patients range from vitamin K antagonists such as warfarin or coumadins, antiplatelet drugs like aspirin or clopidogrel, to newly developed orally available antithrombotics like the direct thrombin inhibitor dabigatran, or the Factor Xa-inhibitor rivaroxaban. The available anticoagulant and antiplatelet drugs have different advantages and disadvantages. This review attempts to delineate the specific role of clopidogrel in patients with AF and at risk of stroke, taking into consideration new and ongoing trials in this important field of medical practice.
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Current Treatment of Venous Thromboembolism
Venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism, is a common disorder with at least 250 000 new events occurring each year in the United States alone. Treatment of venous thromboembolism includes anticoagulation, which is achieved initially with the use of a parenterally administered agent followed by a more prolonged course of treatment with an oral vitamin K antagonist. The duration of treatment depends on the clinical assessment of the benefit-to-risk ratio of prolonged anticoagulation versus the risk of recurrent events. In this review, we discuss some of the issues that we believe are among the most critical unanswered questions in the management of venous thromboembolism in the present era.
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Variation in physician deep vein thrombosis prophylaxis attitudes and practices at an academic tertiary care center
Perceptions of DVT risk factors and prophylaxis practices vary by both physician specialty and attending/resident status. Prophylaxis practice differences may result from these perceptions.
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Vena caval filters for the prevention of pulmonary embolism
No recommendations can be drawn from the two studies. One study showed a reduction in PE rates but not mortality, but was subject to significant biases. The PREPIC study lacked statistical power to detect a reduction in PE over shorter and more clinically significant time periods. However, the trial demonstrated that permanent VCFs were associated with an increased risk of long term lower limb DVT.There is a paucity of VCFs outcome evidence when used within currently approved indications and a lack of trials on retrievable filters. Further trials are needed to assess vena caval filter safety and effectiveness.
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Treatment of venous thromboembolism in patients with cancer: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET)
We describe the results of a systematic literature review and an explicit approach to consensus techniques which resulted in recommendations for the key therapeutic issues in cancer patients with VTE.
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A new deal with new anticoagulants?
The anticoagulant market has been very active recently with the development of new compounds including injectable anti-Xa such as fondaparinux, already available, and idraparinux, already replaced by its new biotynilateed form, and new oral drugs which can be divided into anti-IIa with dabigatran already available, and anti-Xa, such as the recently marketed rivaroxaban and apixaban still in the development stage. Others are coming forward.
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Distal Protection May Increase Stent Thrombosis in PCI
The main findings of the DEDICATION (Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction) trial failed to show a benefit for the use of distal protection on the primary endpoint -- complete ST-segment resolution -- and a trend toward more major cardiac events at one month.
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Venous Thromboembolism and Risk of Idiopathic Interstitial Pneumonia: A Nationwide Study
In the general population, ever diagnosed venous thromboembolism was associated with idiopathic interstitial pneumonia, particularly among those never treated with anticoagulants.
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Relationship between proteinuria and venous thromboembolism
The study population consisted of 284 patients with VTE and 280 age/sex matched controls. Relative to those who did not have proteinuria, patients who tested positive for protein had a 3.4-fold increased risk of VTE (odds ratio (OR) 3.4, 95% confidence interval [2.4, 5.0]). The association was unchanged when adjusted for other risk factors. Patients with proteinuria may have an increased risk of venous thromboembolism.
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Instrumentation Laboratory receives FDA clearance for DVT test
HemosIL D-Dimer HS 500 is a liquid, ready-to-use, automated latex-enhanced immunoassay for the quantitative determination of D-Dimer in human citrated plasma on the ACL TOP Family of Hemostasis Testing Systems for use in conjunction with a clinical pretest probability assessment model to exclude venous thromboembolism in patients suspected of deep venous thrombosis and pulmonary embolism. The company said the assay’s liquid, ready-to-use format, with time to results in less than five minutes, provides customers with superior ease of use and efficiency versus traditional methods.
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The Prevalence of and Specific Risk Factors for Venous Thromboembolic Disease Following Elective Spine Surgery
The risk of deep venous thrombosis and pulmonary embolism is relatively low following elective spine surgery, particularly for patients who receive pharmacologic prophylaxis. Unfortunately, pharmacologic prophylaxis exposes patients to a greater risk of epidural hematoma. More evidence is needed prior to establishing a protocol for prophylaxis against venous thromboembolic disease in patients undergoing elective spine surgery. Future prospective studies should seek to define the safety of various prophylactic modalities and to identify specific subpopulations of patients who are at greater risk for venous thromboembolism.
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Enoxaparin in Primary and Facilitated Percutaneous Coronary Intervention: A Formal Prospective Nonrandomized Substudy of the FINESSE Trial (Facilitated INtervention with Enhanced Reperfusion Speed to Stop Events)
Enoxaparin seems to be associated with a lower risk of cardiovascular outcomes compared with UFH in patients with STEMI undergoing primary PCI. Confirmation of these findings in a randomized study is warranted.
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Recent research on venous thromboembolism in China: a brief report from China Venous Thromboembolism Study Group
VTE is a common problem in modern China. Great achievements have been made in VTE in the past 10 years. The risk factor, diagnosis, management and mechanisms of VTE have been better understood. Clinical trials of PTE, in particular, have shown remarkable advances, especially in managing VTE. Efficient prevention and therapy method have been developed to reduce morbidity and mortality of VTE. The research of the mechanisms, risk factors and therapeutic targets in the VTE has also provided us with a vital opportunity to reassess and recognize the disease.
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Current-OASIS 7 results prompt discussion of proper role of double dose of clopidogrel
The results, according to Robert A. Harrington, MD, a cardiologist at the Duke University Medical Center in Durham, N.C., may not be enough to change practice, but could have an effect on practice via guideline recommendations when taken in totality with other trial results.
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Challenges facing venous thromboembolism in China: more public awareness and research needed
The research on VTE diagnosis and treatment is still limited in China. With a population of more than 1.3 billion, China is potentially a large source of VTE patients for clinical and basic research. Efforts should be made to increase the public awareness and to conduct further research on prevention and early detection of VTE. We hope that all these efforts will help to improve the management of VTE patients in the future.
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Adjunctive Cilostazol Versus High Maintenance Dose Clopidogrel in Patients With AMI (ACCEL-AMI)
After STEMI or non-STEMI patients were treated with stents, there was greater platelet inhibition with cilostazol plus standard-dose clopidogrel, compared with high-dose or standard-dose clopidogrel. In this small study, cilostazol appeared to be well tolerated.
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Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study
Patients with inflammatory bowel disease who develop deep vein thrombosis or pulmonary embolism often have active disease at the time of thromboembolism. We therefore aimed to quantify the risk of venous thromboembolism prospectively during different activity phases of inflammatory bowel disease.
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Intracoronary thrombus formation after drug-eluting stents implantation: Optical coherence tomographic study
Length, size, and types of DES may be more important than clinical factors in intracoronary thrombus formation after DES implantations.
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High hematocrit as a risk factor for venous thrombosis. Cause or innocent bystander?
In conclusion, Brækkan and colleagues have performed an interesting, large-scale study into the relation between high levels of hematocrit and the risk of venous thrombosis. They convincingly demonstrated a dose-response relation between level of hematocrit and risk of venous thrombosis. However, questions remain on the causal interpretation and the clinical consequences of their results.
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Routine use of fondaparinux in acute coronary syndromes: A 2-year multicenter experience
Between 2006 and 2007, the use of fondaparinux in patients with acute coronary syndromes increased considerably, either because it was used instead of enoxaparin or because of a switch from UFH. Adjusted mortality in patients treated with fondaparinux was lower than with UFH and similar to enoxaparin.
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The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation
In this nonrandomized study, the risk–benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate-high risk of TE. This conclusion needs to be confirmed by future large randomized trials.
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Primary care practices and determinants of optimal anticoagulation management in a collaborative care model
Primary care physicians are poorly supported by technological and human resources to monitor patients on oral anticoagulant. Even in a CCM, interprofessional collaboration and better technological support may be associated with optimal INR control.
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Slow Response to Clopidogrel Predicts Low Response
Slow response to clopidogrel, within the first hour of administration, is a reliable marker of low response at 24 h and high post-treatment platelet reactivity.
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Superficial Venous Thrombosis and Venous Thromboembolism - A Large, Prospective Epidemiologic Study
A substantial number of patients with SVT exhibit venous thromboembolism at presentation, and some that do not can develop this complication in the subsequent 3 months.
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The perioperative use of oral anticoagulants during surgical procedures for carpal tunnel syndrome. A preliminary study
Continuation of anticoagulant treatment is safe for OCTR. The adverse effects of stopping treatment for surgery can be severe. As a result of this study, we have changed our surgery protocol for OCTR and continue anticoagulant treatment perioperatively.
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Antiplatelet Therapy Approaches for PCI Evaluated
Patients who receive a loading dose of clopidogrel just before percutaneous coronary intervention (PCI) have similar ischemic and mortality outcomes to those who receive the antiplatelet therapy well in advance of the procedure (as recommended in professional guidelines), according to research published in the Feb. 1 issue of the American Journal of Cardiology.
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Periprocedural Anticoagulation Management of Patients With Venous Thromboembolism
Thromboembolism, bleeding, and death among VTE patients in whom anticoagulation is temporarily interrupted for an invasive procedure is low. Cancer patients require particular care given their propensity for both clotting and bleeding.
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Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban in preclinical and clinical development
Phase III trials in orthopaedic patients essentially resulted in non-inferior efficacy of dabigatran and superior efficacy of rivaroxaban over enoxaparin without any marked differences of drug safety, while apixaban data is still controversial. However, alterations of rivaroxaban and apixaban pharmacokinetics upon interactions with inhibitors and inducers of CYP3A4 or P-glycoprotein may complicate the use of these compounds in daily practice, whereas dabigatran elimination largely depends on renal function. Hence, this review reports PK/PD, efficacy and safety data of dabigatran, rivaroxaban and apixaban throughout preclinical and clinical development.
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Thromboembolism in Atrial Fibrillation
In conclusion, atrial fibrillation predisposes to thromboembolism. If ischemic stroke or systemic thromboembolism occurs, early diagnosis and treatment can improve outcomes. The thromboembolic risks are reduced by guideline-adherent antithrombotic therapy with warfarin or aspirin. Future directions may include self-monitoring of the international normalized ratio and novel anticoagulants.
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Preventing venous thromboembolism in long-term care residents: Cautious advice based on limited data
In hospitalized medical patients, randomized trials have established that anticoagulant prophylaxis has an acceptable benefit-to-risk ratio: ie, it lowers the incidence of clinically silent and symptomatic venous thromboembolism (VTE), including fatal pulmonary embolism, more than it raises the risks of bleeding and other complications. However, no similar trials have been done in long-term care residents. More research is needed to ascertain which long-term care residents would benefit most from VTE prophylaxis. In the absence of evidence-based guidelines, we advocate a selective approach.
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Bedside Blood Test Found to Detect Anticoagulation Status
A new bedside blood test can be used to determine the sufficiency of anticoagulation in patients who are about to undergo catheterization or percutaneous coronary intervention (PCI), according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.
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Active inflammatory bowel disease greatly increased risk for VTE
The risk for venous thromboembolism was 15.8-fold higher among nonhospitalized patients with active inflammatory bowel disease compared with the nonhospitalized general population.
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Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey
In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients.
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Oral Prevention of Thromboembolism with Rivaroxaban and Dabigatran: Are the Newly Approved Drugs Innovations in Orthopaedic and Trauma Surgery?
In parallel 2 new oral anticoagulants have been approved for the prevention of thromboembolic events after elective knee and hip replacement. Dabigatran is an oral thrombin inhibitor. Compared to enoxaparin it has a comparable profile of side effects and efficacy. Rivaroxaban is an oral Xa inhibitor which shows a sigificantly better efficacy compared to enoxaparin and no difference in side effects. The significant reduction of symptomatic thromboembolisms after elective knee and hip replacement was shown for rivaroxaban compared to enoxaparin in a pooled analysis of phase III data. This review discusses the main topics of the new German guideline and impact of the new oral anticoagulants on in- and outpatient treatment procedures.
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Atrial Fibrillation Can Be A Family Affair
Recent studies suggest that up to 30 percent of all people with AF may have a history of the condition in their family. Most cases of atrial fibrillation are not caused by mutations in a single gene.
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Updated Analysis of Gene Variants Associated With Deep Vein Thrombosis
A single-nucleotide polymorphism (SNP) association study assessing variants associated with deep vein thrombosis found that, of 19 682 gene-centric SNPs, 18 were consistently associated with deep vein thrombosis in the Leiden Thrombophilia Study (LETS) and in a subset of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA-1). Nine of these SNPs were genotyped in the remaining part of the MEGA study (MEGA-2). Assays for the other 9 SNPs for MEGA-2 were not available at that time; the associations of these 9 SNPs with venous thrombosis in 1314 cases and 2877 controls of MEGA-2 were subsequently assessed.
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'Significant' improvement in stroke care in England
Stroke care in England has improved significantly over the past four years, according to a National Audit Office report. A patient's chance of dying within 10 years of having a stroke has decreased from 71% in 2006 to 67% in 2010, say the authors of the report.
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Early anticoagulation may improve survival after pulmonary embolism
Starting heparin in the emergency department (ED) rather than after admission may improve the survival of patients with acute pulmonary embolism (PE), according to a Mayo Clinic study. In-hospital mortality for patients receiving ED anticoagulation was 1.4%, much lower than the 6.7% in patients treated after hospital admission (p = 0.009).
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Risk of Deep Vein Thrombosis Following a Single Negative Whole-Leg Compression Ultrasound
In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-leg CUS may exclude proximal and distal DVT in a single evaluation.
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Relation of Effective Anticoagulation in Patients With Atrial Fibrillation to Stroke Severity and Survival (from the National Acute Stroke Israeli Survey [NASIS])
In conclusion, in addition to its established benefit for stroke prevention, effective anticoagulation therapy is associated with decreased stroke severity and better functional outcome and survival in patients with AF presenting with acute brain ischemia.
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Triple antiplatelet therapy after PCI with aspirin, clopidogrel and cilostazol
Current data suggest that triple antiplatelet therapy is at least as safe as standard dual antiplatelet therapy and may be more beneficial than dual antiplatelet therapy in preventing stent thrombosis, especially in high-risk patients. High-risk patients would include women, patients aged older than 65 years, patients with diabetes and recipients of drug-eluting stents or long stents.
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Malignancy and venous thrombosis in the critical care patient
Venous thromboembolic disease has significant clinical consequences. There are few data available to guide its management in the critically ill cancer patient, perhaps the most complex and challenging patient population encountered.
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Antithrombotic Therapy for Ischemic Stroke in Childhood
Investigators from the International Pediatric Stroke Study Group (IPSSG) conducted an observational study of acute arterial ischemic stroke (AIS) in children to describe frequency, acute therapeutic interventions, early outcomes, and prognostic factors. The IPSS has 33 participating centers on five continents. Patients aged 28 days to 19 years were enrolled at each center between 2003 and 2007.
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The Prevalence of and Specific Risk Factors for Venous Thromboembolic Disease Following Elective Spine Surgery
Fourteen studies (including a total of 4383 patients) met our selection criteria. On the basis of the meta-analysis, the prevalence of deep venous thrombosis was 1.09% (95% confidence interval, 0.54% to 1.64%) and the prevalence of pulmonary embolism was 0.06% (95% confidence interval, 0.01% to 0.12%) following elective spine surgery. The use of pharmacologic prophylaxis significantly reduced the prevalence of deep venous thrombosis relative to either mechanical prophylaxis (p = 0.047) or no prophylaxis (p < 0.01). One fatal pulmonary embolism was reported. An epidural hematoma requiring surgical evacuation was reported in eight of 2071 patients receiving pharmacologic prophylaxis; three of these patients had a permanent neurologic deficit.
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Nurse training in VTE prevention must be mandatory
Portsmouth Hospitals Trust DVT nurse specialist Kim Carter said training nurses in the prevention of VTE was “essential” if they were to be competent at risk assessing patients. “Carrying out a risk assessment for DVT could be done by junior nurses as part of a patient’s routine admission. But unless they are given the appropriate training and education in DVT prevention they will not be able to carry out the risk assessment safely,” she said.
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No Rebound Seen After Antiplatelet Withdrawal
Values for adenosine diphosphate (ADP)-induced platelet aggregation did not differ significantly between patients whose clopidogrel therapy was withdrawn abruptly and those in whom clopidogrel was tapered before discontinuation, they wrote in an article in the Feb. 9 issue of the Journal of the American College of Cardiology.
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Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Death
All sudden death cases referred to the Examiner’s Office between 2005 and 2006 were reviewed. Of the 345 deaths reviewed, 181 died from coronary thrombi (129 ruptures and 52 erosions). A total of 111 cases with available demographic and pathologic data were included in this analysis.
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Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study
The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI) is unclear. We studied the risk of death or recurrent myocardial infarction (MI) in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI.
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Thrombosis in primary myelofibrosis: incidence and risk factors
This study is the largest hitherto carried out in this setting and shows that the rate of major CV events in PMF is comparable with that reported in essential thrombocythemia, and it is increased in aged patients and those with JAK2 V617F mutation and leukocytosis.
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High Residual Platelet Reactivity After Clopidogrel
Patients with more extensive coronary atherosclerosis have a higher rate of HPR, which might partly account for higher risk of periprocedural MI.
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Venous Thromboembolism in Hospitalized Patients With Heart Failure
Recent data from several large registries of HF hospitalizations have demonstrated in-hospital mortality as high as 4% to 7%. Contributing to this is a significant incidence of VTE among hospitalized patients with HF. In addition, VTE is associated with thromboembolic complications, which are associated with long-term sequelae including postthrombotic syndromes, venous stasis, venous ulcers, chronic thromboembolic pulmonary hypertension, and pulmonary embolism (PE).
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NICE blood clot guideline to save thousands of lives
An estimated 25,000 people who are admitted to hospital die from preventable venous thromboembolism each year. The NICE guideline, jointly developed with the National Clinical Guideline Centre for Acute and Chronic Conditions, recommends that all patients should be assessed for risk of developing blood clots on admission to hospital, and then given preventative treatment that suits their individual needs.
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All hospital patients 'to be checked for risk of potentially fatal blood clot'
All hospital patients in England are to be assessed for their risk of suffering a potentially fatal blood clot in a move which could save more than 10,000 lives a year. From April hospitals face losing money if they do not check patients, after the Chief Medical Officer declared cutting the number of deaths from the condition was a “priority”.
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Incidence and risk factors for venous thromboembolism in critically ill children after trauma
VTE is not a rare event in critically ill children after trauma. Most patients developing thrombosis have multiple risk factors, including poor perfusion, immobility, and presence of a CVL.
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New Gene Variant Found to Boost Clopidogrel Response, Bleeding Risk
While the drug-metabolizing liver enzyme cytochrome 450 (CYP) 2C19 has garnered the most attention for a genetic variant that reduces response to clopidogrel, new research has uncovered another allele that may have the opposite effect—enhancing clopidogrel response. And in doing so, it also appears to increase bleeding risk, according to findings published online January 18, 2010, ahead of print in Circulation.
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Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study
Recanalization occurs in one-third of patients receiving early anticoagulation for acute portal vein thrombosis, whereas thrombus extension, intestinal infarction, severe bleeding, and death are rare. Alternative therapy should be considered when ascites and splenic vein obstruction are present.
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Early Anticoagulation is Associated with Reduced Mortality for Acute Pulmonary Embolism
We studied 400 consecutive emergency department (ED) patients diagnosed with acute PE by CT angiography and treated in the hospital with IV unfractionated heparin from 2002 to 2005. Patients received heparin either in the ED or after admission. Time from ED arrival to therapeutic activated partial thromboplastin time (aPTT) was calculated. Outcomes included in-hospital and 30-day mortality, hospital and intensive care unit (ICU) lengths-of-stay, hemorrhagic events on heparin, and recurrent venous thromboembolism (VTE) within 90 days.
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Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study
The PROLONG randomized trial showed that a normal D-dimer (D-d) 1 month after anticoagulation suspension for unprovoked venous thromboembolism (VTE) was associated with a low risk of late recurrences (4.4% patient years). However, it is unknown whether D-d changes subsequently. The aim of this prospective multicenter study was to assess D-d time course and its relation with late recurrences in patients with normal D-d 1 month after anticoagulation suspension for a first episode of unprovoked VTE.
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Experts warn that too much sitting could be deadly
The belief that sitting for too long is bad for people's health is not new. In 2005 the Medical Research Institute of New Zealand in Wellington studied 62 people who suffered from deep vein thrombosis (DVT), including taxi drivers, IT workers and managers, and found 34 percent of the cases were a result of being seated for long periods at work. However, a family history of DVT was also a significant factor in getting the disease, the study said.
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2010 NHS Operating Framework Mandates Venous Thromboembolism Prevention in the NHS
The All-Party Parliamentary Thrombosis Group (APPTG) has recently welcomed the Department of Health’s (DH) decision to mandate venous thromboembolism (VTE) prevention in the Operating Framework for the NHS in 2010/11. The All Party Group has been campaigning for its inclusion as a key step in reducing up to 25,000 annual avoidable deaths and saving the NHS over half a billion pounds a year.
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Statins, Fibrates, and Venous Thromboembolism: A Meta-Analysis
This meta-analysis of available literature suggests that statins may lower the risk of VTE, whereas fibrates may increase the risk. Due to several methodological limitations, this conclusion should be considered with caution, and additional, specifically designed RCTs are warranted.
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Tumor thrombus involving the inferior vena cava in renal malignancy: is there a difference in clinical presentation and outcome among right and left side tumors?
A level-III IVC tumor thrombus is more frequently seen with a right side tumor. However, clinical and operative characteristics among the left and right sided tumors with IVC thrombus were not different. More significantly, recurrence rate and survival did not differ with the laterality of the tumor.
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Venous Thromboembolism in Hospitalized Patients With Heart Failure
Published information suggests that despite availability of effective therapy and existence of practice guidelines, there is a significant underutilization of VTE prophylaxis in hospitalized patients with HF. Analysis of the Acute Decompensated Heart Failure National Registry revealed that of 71,376 patients eligible for VTE prophylaxis only 21,847 (31%) received prophylactic regimen.
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Persistent Use of Secondary Preventive Drugs Declines Rapidly During the First 2 Years After Stroke
The proportion of patients who were persistent users of drugs prescribed at discharge from hospital declined progressively over the first 2 years to reach 74.2% for antihypertensive drugs, 56.1% for statins, 63.7% for antiplatelet drugs, and 45.0% for warfarin. For most drugs, advanced age, comorbidity, good self-perceived health, absence of low mood, acute treatment in a stroke unit, and institutional living at follow-up were independently associated with persistent medication use.
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Impact of small thrombus formation in restenotic bare-metal stent lesions associated with acute coronary syndrome: Identification by optical coherence tomography
One third of ISR lesions following BMS deployment dominantly contained a white thrombus, and half of them were associated with ACS. A small thrombus formation adjacent to the narrowest lumen in an ISR lesion may therefore contribute to the clinical presentation of ACS.
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Venous Thromboembolism Risk and Prophylaxis in the Acute Care Hospital Setting (ENDORSE Survey): Findings in Surgical Patients
The majority of surgical patients are at high-risk for VTE. Despite long-standing recognition of the high-risk for VTE in surgical patients, thromboprophylaxis remains underutilized.
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Risk of venous thromboembolism among users of oral contraceptives: a review of two recently published studies
The best evidence continues to suggest that the increased risk of VTE in OC users is a class effect, dependent on the estrogen dose and duration of use, and independent of the progestogen used.
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Statins Decrease the Occurrence of Venous Thromboembolism in Patients with Cancer
Among patients receiving statins, 8% (N=16) developed a venous thromboembolism compared with 21% (N=116) in the control group (odds ratio 0.33; 95% confidence interval, 0.19-0.57).
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Comparison between single antiplatelet therapy and combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome
The recent APASS study did not show any difference in effectiveness for secondary prevention between single antiplatelet (aspirin) and single anticoagulant (warfarin) therapy. Our results indicate that combination therapy may be more effective in APS-related ischemic stroke.
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DVT prophylaxis remains an issue for trauma surgeons
Even though most of the attention regarding deep vein thrombosis and pulmonary embolism prevention is focused on total joint reconstruction in the orthopedic community, trauma surgeons also have to deal with this problematic issue, according to a former president of the American Academy of Orthopaedic Surgeons.
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Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment
Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis.
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Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study
6732 patients were assigned to ticagrelor and 6676 to clopidogrel. The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group (569 [event rate at 360 days 9·0%] vs 668 [10·7%], hazard ratio 0·84, 95% CI 0·75—0·94; p=0·0025). There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding (691 [11·6%] vs 689 [11·5%], 0·99 [0·89—1·10]; p=0·8803) or severe bleeding, as defined according to the Global Use of Strategies To Open occluded coronary arteries, (198 [3·2%] vs 185 [2·9%], 0·91 [0·74—1·12]; p=0·3785).
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The clinical implications of new oral anticoagulants: Will the potential advantages be achieved?
With the advent of new oral anticoagulants a thorough assessment and evaluation of benefits weighed against potential risks must be conducted. In a practical sense, what will these new agents really offer to the healthcare system, to practitioners, and to patients?
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Solid malignancies complicated with pulmonary embolism: clinical analysis of 120 patients
Patients with cancer of the lung, ovarian, breast, pancreas, and liver are more likely to be complicated with pulmonary embolism than those with other types of solid tumors. Patients with distant metastasis are at a higher risk of pulmonary embolism. Pulmonary embolism without concurrent deep venous thrombosis is more frequently observed than concurrence of both disorders in the clinical setting.
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One-stage bilateral UKR patients more susceptible to major complications
According to the study, major complications — recorded as death, pulmonary emboli (PE), proximal deep-vein thromboses (DVT) and adverse cardiac events within the first 30 days — occurred in 13 one-stage UKR patients as compared to none in the two-stage UKR patient group. None of the outcomes could be associated with the surgeons involved.
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Differentiation of Malignant Thrombus from Bland Thrombus of the Portal Vein in Patients with Hepatocellular Carcinoma: Application of Diffusion-weighted MR Imaging
DW imaging enables discrimination between bland and neoplastic portal vein thrombi when the ratio of the ADC of the thrombus to the ADC of HCC was lower than 2 and when the thrombi showed similar SI as the primary HCC when qualitative analysis was performed.
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Safety, pharmacokinetics and pharmacodynamics of single doses of rivaroxaban – an oral, direct factor Xa inhibitor – in elderly Chinese subjects
In conclusion, rivaroxaban was well tolerated and was found to have predictable PK and PD in healthy, elderly Chinese subjects.
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Venous Thromboembolism Prophylaxis: Implementing a Program That Works
Venous thromboembolism (VTE), including DVT and pulmonary embolic (PE) disease, is the most common preventable cause of hospital death. The approximate annual incidence of VTE in the United States is 900,000 cases. About 300,000 people die of PE each year. A large number of the deaths are preventable.
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Clinical Conundrum: Two Differing Guidelines on VTE Prevention in Hip and Knee Surgery—Implications and Recommendations
The ACCP guidelines include asymptomatic and symptomatic DVT detected by venography as a measure of efficacy of prophylaxis, whereas the AAOS guidelines rejected DVT as a valid outcome because the panelists considered the link between DVT and PE to be unproven. Given that prevention of VTE is a major national patient safety priority, it is imperative that clinicians receive clear guidance on how to approach the issue so that quality of care can be optimized.
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The new oral anticoagulants
Three new orally administered anticoagulants (apixaban, dabigatran, and rivaroxaban) are in the late stages of development and several others are just entering (or moving through) earlier phases of investigation. These novel anticoagulant medications are being studied for the prevention and treatment of venous thromboembolism, the treatment of acute coronary syndromes and the prevention of stroke in patients with atrial fibrillation. This review will summarize published clinical trial data pertinent to apixaban, dabigatran and rivaroxaban.
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Researchers Hope Measuring Performance Will Improve Stroke Care and Prevention
The analysis found that participating hospitals during 2005-2007, compared with the 2001-2004 prototype phase, substantially improved their rates of antithrombotic therapy prescribed at discharge, smoking cessation counseling, lipid testing, and dysphagia screening. However, the frequency of delivery of recombinant tissue plasminogen activator (rt-PA) to eligible patients and of transport of patients to the hospital by emergency medical services (EMS) remained stubbornly low.
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Rapid Treatment for Acute Deep Vein Thrombosis Can Save Lives, Reduce Hospital Stays
Patients with acute deep vein thrombosis (DVT) develop potentially dangerous blood clots and can suffer severe leg pain and swelling. Doctors with Virginia Interventional & Vascular Associates (VIVA) report success over the past two years in treating acute DVT patients with a procedure called isolated pharmacomechanical thrombolysis (IPMT), which destroys clots much faster than traditional therapies.
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Enoxaparin Versus Unfractionated Heparin in Elective Percutaneous Coronary Intervention: 1-Year Results From the STEEPLE (SafeTy and Efficacy of Enoxaparin in Percutaneous Coronary Intervention Patients, An InternationaL randomized Evaluation) Trial
One-year follow-up data were available for 2,636 patients. There was no difference in the risk of death from randomization to 1 year among patients treated with 0.50 mg/kg enoxaparin (2.3%), 0.75 mg/kg enoxaparin (2.2%), or UFH (1.9%).
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High platelet count predicted VTE in patients with cancer
There are limited data on parameters with predictive value for patients with VTE even though there are many risk factors, according to researchers. To examine the relationship between platelet count and VTE risk, they analyzed data from 665 patients with solid tumors.
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Warfarin seems to increases Mortality in Trauma Patients
The study confirmed the researchers’ anecdotal impression that the prevalence of patients on warfarin among trauma patients is increasing, especially among older patients. In 2002, 2.3% of all patients in the database were on warfarin vs 4% in 2007. The fraction of trauma patients over 65 taking warfarin grew from 7.3% to 12.8% during that period.
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Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: application of diffusion-weighted MR imaging
DW imaging enables discrimination between bland and neoplastic portal vein thrombi when the ratio of the ADC of the thrombus to the ADC of HCC was lower than 2 and when the thrombi showed similar SI as the primary HCC when qualitative analysis was performed.
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Body mass index predicts left atrial thrombus in atrial fibrillation
In patients with atrial fibrillation, a body mass index (BMI) of 27.0 kg/meters-squared or higher increases the risk for left atrial/left atrial appendage (LA/LAA) thrombi, according to a report in the December 15th American Journal of Cardiology.
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Coagulopathy Does Not Protect Against Venous Thromboembolism in Hospitalized Patients with Chronic Liver Disease
An elevated INR in the setting of CLD does not appear to protect against the development of hospital-acquired VTE. The notion that "auto-anticoagulation" protects against VTE is unfounded. Utilization of DVT prophylaxis was extremely low in this population.
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High Incidence of Complications From Enoxaparin Treatment After Arthroplasty
The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.
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What is the appropriate approach to prevention of thromboembolism in heart failure?
Retrospective analyses of large HF trials have yielded contradictory results and randomised trials designed to specifically address this question have been under-populated and under-powered. As a result, there is no general consensus among professional societies in either recommending or advising against anticoagulants in HF.
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The TRITON versus PLATO trials: Differences beyond platelet inhibition
However, unless the regulatory authorities discover some unexpected serious flaws with PLATO, the ticagrelor will substantially change the present landscape of oral antiplatelet therapy, especially in high-risk patients, diabetics, and those with repeated vascular events including stent thrombosis. In contrast, a too exclusive trial design, a lack of persistent vascular benefit despite issues with event adjudication, growing-over-time bleeding complications, an issue with cancer, and finally an increase in mortality risk will likely prevent a broad prasugrel implementation, unless more reassuring evidence becomes available.
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Can Air Flights Cause DVT When On Holidays And Vacations?
People who take air flights when they travel on their vacations and holidays can be at risk of developing a serious medical condition called deep vein thrombosis, or DVT, which can be life threatening. The following article covers travel tips on how you can prevent this potential problem from developing into a serious medical condition when you travel on airline flights.
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CT Preferred for Pulmonary Embolism Diagnosis
Ninety percent of radiologists and 96% of emergency physicians use CT as their first-line choice for the diagnosis of pulmonary embolism, according to a report published online Dec. 22 in the American Journal of Roentgenology. Other diagnostic techniques were used less regularly, with magnetic resonance imaging (MRI) used infrequently and ventilation-perfusion scintigraphy typically used in patients with renal failure or allergies to the iodine-based contrast material used for CT.
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New checklist to help cut fatal blood clots
A NEW checklist has been introduced in Welsh hospitals in an attempt to stop patients developing life-threatening blood clots. All patients will now be properly risk assessed for these blood clots and given early and appropriate treatment.
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Major Bleeding, Mortality, and Efficacy of Fondaparinux in Venous Thromboembolism Prevention Trials
The authors concluded that major bleeding in hospitalized surgical and medical patients participating in VTE prevention trials is a strong predictor of mortality.
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SPECT as accurate as CT for diagnosing pulmonary embolism
"CTPA offers additional imaging information, but SPECT ventilation/perfusion (V/Q) scintigraphy produces a markedly lower radiation dose, which is important in women of reproductive age, and may have additional advantages of a higher rate of diagnostic scans and greater interobserver reproducibility than planar V/Q scintigraphy or CTPA," lead author Dr. Susan Miles, from Calvary Mater Newcastle, New South Wales, Australia, and colleagues note in the December issue of CHEST.
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Tuberculosis and Venous Thromboembolism: a case series
An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician`s awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.
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Clot prevention is 2010-11 quality priority
NHS medical director Sir Bruce Keogh has said preventing venous thromboembolism will be the top clinical priority for improving quality and productivity in hospitals in 2010-11.
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Contraindicated Medication Use in Dialysis Patients Undergoing Percutaneous Coronary Intervention
"The fact that use of enoxaparin and eptifibatide increases risk of bleeding in patients on dialysis is not a surprise. I was, however, surprised by how commonly these drugs are used in this population. There are good alternatives available (unfractionated heparin, bivalirudin, abciximab) that are safer in patients on dialysis and should be preferentially used to reduce the bleeding risk in this population." Hitinder S. Gurm, M.B.B.S., F.A.C.C.
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Nurses central to new wave of patient safety initiatives
The NHS has been told to reduce venous thromboembolism and pressure ulcers and improve diabetic inpatient care in a government document setting out the service’s priorities for next year. The Department of Health is also considering whether VTE and pressure ulcers should be added to a list of seven “never events” deemed unacceptable.
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Thromboembolic complications of sling surgery for stress urinary incontinence among female medicare beneficiaries
Our results show a low rate of thromboembolism after an isolated sling procedure. However, we found an increased rate of deep venous thrombosis and pulmonary embolism among women undergoing sling surgery with prolapse repair, which emphasizes the need for appropriate deep venous thrombosis prophylaxis in this patient group.
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Diabetes UK Gives Its Support To Stroke Awareness Campaign
Cathy Moulton, Care Advisor at Diabetes UK said, "Diabetes is one of the risk factors for having a stroke. Poorly controlled diabetes can lead to the furring up of arteries and high blood pressure both of which can cause a stroke. This is why this campaign is so important and has received the backing of Diabetes UK."
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Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non–ST-elevation acute coronary syndrome patients: The Canadian Global Registry of Acute Coronary Events (GRACE) experience
In this contemporary NSTE-ACS population, both clopidogrel and GpIIb/IIIa inhibitors were targeted toward patients treated with an invasive strategy but paradoxically toward the lower-risk group. In particular, clopidogrel appeared to be underused among conservatively managed patients despite its proven efficacy, whereas GpIIb/IIIa inhibitors were administered to only a minority of the high-risk patients with elevated cardiac biomarkers. Our findings emphasize the ongoing need to promote the optimal use of evidence-based antiplatelet therapies among high-risk patients with NSTE-ACS.
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Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data
In patients with myocardial infarction, risk of hospital admission for bleeding increased with the number of antithrombotic drugs used. Treatment with triple therapy or dual therapy with clopidogrel plus vitamin K antagonist should be prescribed only after thorough individual risk assessment.
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Three Anticoagulant Studies May Change Current Medical Practice
Blood clotting, or coagulation, is an important process that prevents excessive bleeding when a blood vessel is injured. Sometimes, however, clots form on the inside of vessels without an obvious injury or do not dissolve naturally, a potentially life-threatening situation requiring treatment.
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Treatment After Stenting Affects Thrombosis Risk
Gaetano Tanzilli, M.D., from La Sapienza University in Rome, and colleagues examined the risk of very late thrombosis in 897 patients who underwent PCI with stenting and had dual antiplatelet therapy (aspirin and clopidogrel) for 12 or 24 months. Of these, 450 patients received bare metal stents and 447 patients received drug-eluting stents. After four years of follow-up, in patients receiving drug-eluting stents, the researchers found significantly fewer cases of stent thrombosis in the 24-month group than the 12-month group (one versus five). The one case in the 24-month group was subacute thrombosis, while in the 12-month group, one case was subacute thrombosis and four cases were very late thrombosis.
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Updated Guidelines for the Management of Antithrombotic Agents for Endoscopic Procedures
When high-risk procedures are planned, clinicians may elect to discontinue aspirin and/or NSAIDs for 5 to 7 days before the procedure, depending on the underlying indication for antiplatelet therapy. For patients on temporary anticoagulation therapy, it is suggested that elective endoscopic procedures be deferred until antithrombotic therapy is completed.
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Capnometry in suspected pulmonary embolism with positive D-dimer on the field
Pulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests.
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New Health Report Exposes Imminent Risk of a Stroke Crisis in Europe
"It is clear that there is an unmet medical need for stroke prevention in atrial fibrillation patients," said Professor Gregory Lip, Professor of Cardiovascular Medicine, from the University of Birmingham Centre for Cardiovascular Sciences, City Hospital Birmingham, UK. "The majority of such strokes are preventable but the under-diagnosis and poor management of AF patients, as well as suboptimal use of anticoagulation and side-effects of current treatments, mean that an unnecessary and heavy burden is placed on patients, their families and carers, as well as our healthcare systems."
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Venous thromboembolism prophylaxis in the medical patient: controversies and perspectives
Despite the high morbidity and mortality associated with venous thromboembolism in hospitalized at-risk medical patients, the publication of large-scale studies showing that prophylaxis is effective in this patient group, and the presence of international guidelines, prophylaxis rates in medically ill patients remain suboptimal.
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Diagnosis of deep-vein thrombosis: Adherence to guidelines and outcomes in real-world health care
This nationwide evaluation in German ambulatory care revealed that the diagnostic work-up for suspected DVT did not adhere to current guidelines. However, the overall diagnostic safety was excellent, although there is potential for improvement in a well defined minority of patients.
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Association of influenza vaccination with reduced risk of venous thromboembolism
It was the aim of this study to investigate whether influenza vaccination reduces the risk of VTE. We conducted a case-control study involving 1,454 adults enrolled in 11 French centers between 2003 and 2007, comprising 727 consecutive cases with a first documented episode of VTE and 727 age- and sex-matched controls.
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Dialysis Patients Undergoing PCI Often Get Wrong Antithrombotics
Patients who received the antiplatelet agent eptifibatide or the anticoagulant enoxaparin, which are renally cleared and therefore not recommended for dialysis patients, had higher unadjusted rates of inhospital bleeding (5.6% versus 2.9%, OR 1.93, 95% CI 1.66 to 2.23) than patients who received recommended antithrombotics, according to Thomas T. Tsai, MD, of the Denver VA Medical Center, and colleagues. Patients who were given these drugs also had higher rates of all-cause inhospital death (6.5% versus 3.9%, OR 1.68, 95% CI 1.46 to 1.95), the investigators reported in the Dec. 9 Journal of the American Medical Association.
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ASH: Some Cancer Patients Get VTE Benefit from LMWH
Low molecular weight heparin may prevent blood clots in patients with pancreatic cancer, but patients with other types of malignancies might not receive much benefit from the treatment, researchers said here.
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ASH: Fondaparinux Found to Reduce SVT Complications
In all, 5.9% of the placebo group experienced one or more of the complications that made up the composite primary outcome measure of the study, which also included SVT recurrence or extension in addition to pulmonary embolism and deep vein thrombosis. None of the 1,500 patients assigned to daily injections of 2.5 mg of fondaparinux had pulmonary embolism (P=0.03 versus placebo) and 0.2% experienced deep vein thrombosis (P<0.001). Recurrent and extended SVT both occurred in 0.3% of the fondaparinux group (P<0.001 versus placebo for both).
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Thromboprophylaxis with LMWH, warfarin, low-dose aspirin, safe in newly diagnosed multiple myeloma
Despite the recommendation for anticoagulant prophylaxis in people with newly diagnosed multiple myeloma, controversies exist over the best thromboprophylactic regimen to adopt. Today, at the 51st ASH Annual Meeting, an investigator of the Italian Multiple Myeloma Network presented data indicating that the use of thromboprophylaxis with low-molecular weight heparin, warfarin or low-dose aspirin were all equally safe and effective to prevent venous thromboembolism in this patient group.
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ASH: Data Do Not Support Anticoagulation to Prevent Recurrent Miscarriage
"About 1% to 3% of women have recurrent miscarriage, and about 50% of the reasons for those miscarriages are unexplained," said Stef Kaandorp, MD, University of Amsterdam, Amsterdam, Netherlands. "Because many of these women are desperate to have children, their physicians will often 'do something' and that includes offering anticoagulation therapy."
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Phase III EINSTEIN-Extension Study of Bayer’s Rivaroxaban Shows Significant Benefit in the Prevention of Secondary Symptomatic VTE
“We are delighted that rivaroxaban has now also shown benefit in a chronic setting. Rivaroxaban has previously demonstrated superior efficacy to the current standard treatment in the prevention of VTE after orthopedic surgery in all four RECORD trials. Therefore, this is the fifth study in a row in a total of more than 13,500 patients, in which rivaroxaban has shown consistent benefit in reducing the risk of VTE in patients,” said Kemal Malik, M.D., member of the Board of Management of Bayer Schering Pharma AG, Germany, responsible for Global Development.
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VTE Prophylaxis Uncommon in At-Risk Patients
Only a third of hospitalized medical patients at risk of venous thromboembolism (VTE) received prophylaxis, which lasted only three days when it was given, a retrospective review of a large claims databases showed.
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Fixed-dose dabigatran as safe, effective as warfarin for VTE
After six months of treatment, 2.4% of patients assigned to dabigatran and 2.2% of patients assigned to warfarin experienced recurrent VTE. Safety was comparable between the two drugs.
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Three Anticoagulant Studies May Change Current Medical Practice Including New Data Revealing That Preventative Use of Aspirin and Heparin is Not Effective in Reducing Recurrent, Unexplained Miscarriages
Blood clotting, or coagulation, is an important process that prevents excessive bleeding when a blood vessel is injured. Sometimes, however, clots form on the inside of vessels without an obvious injury or do not dissolve naturally, a potentially life-threatening situation requiring treatment. Research presented today at the 51st Annual Meeting of the American Society of Hematology reveals that the practice of using the anticoagulants aspirin and heparin with the hope of preventing clots in placental blood vessels is ineffective for preventing unexplained, recurrent miscarriages. Two other studies look at treatments for venous thromboembolism, a common and sometimes deadly clotting disorder.
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VTE guideline to prevent hospital deaths
Health professionals are being encouraged to use a new clinical practice guideline for the prevention of venous thromboembolism (VTE) in an aim to prevent the risk of potentially fatal blood clots in post-surgery patients.
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Medication to prevent thrombosis receives German prize
A medication for treating thrombosis developed by German scientist Frank Misselwitz and his research team, along with German pharmaceutical giant Bayer, has been awarded the 2009 Deutscher Zukunftspreis (German Future Prize) by President Horst Köhler.
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Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study
The risk of deep vein thrombosis and pulmonary embolism after surgery is substantially increased in the first 12 postoperative weeks, and varies considerably by type of surgery. An estimated 1 in 140 middle aged women undergoing inpatient surgery in the UK will be admitted with venous thromboembolism during the 12 weeks after surgery (1 in 45 after hip or knee replacement and 1 in 85 after surgery for cancer), compared with 1 in 815 after day case surgery and only 1 in 6200 women during a 12 week period without surgery.
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51st Annual Meeting of the American Society of Hematology Will Highlight Research and Policy Changes Affecting Medical Practice and Patient Care
The Special Symposium on the Basic Science of Hemostasis and Thrombosis will focus on this year's most important basic science contributions to each of the three major areas of the field: thrombosis, blood coagulation and fibrinolysis, and platelet biology. The invited presentations for the symposium will take place on Tuesday, December 8, from 7:30 - 9:00 a.m., and simultaneous oral sessions will take place from 12:00 - 1:30 p.m.
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Prevention of deep vein thrombosis and pulmonary embolus
A range of mechanical and pharmacological interventions have been shown to significantly reduce the risk. A number of anaesthetic interventions are also recommended. Newer oral anticoagulants have been recommended for use after specific high-risk procedures.
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Clearing the way for detecting pulmonary embolism
Their study found that SPECT plus low-dose CT had a sensitivity of 97% and a specificity of 100%, whereas MDCT alone had a sensitivity of 68% and a specificity of 100%. Having an effective technique for diagnosing pulmonary embolism leads to more rapid and successful diagnosis.
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Lifestyle factors contribute to women's venous thromboembolism risk
In a report published online ahead of print in the American Journal of Public Health, the research team writes, "Although much VTE risk is perceived to be the consequence of nonmodifiable risk factors, these data provide a spotlight on several modifiable VTE risk factors that might be potential intervention targets."
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Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding
Prothrombin complex concentrates (PCCs) are recommended for rapid reversal of vitamin K anticoagulants. As they normalize levels of vitamin K dependent clotting factors and re-establish hemostasis, they may also be used as adjunctive therapy in patients with major bleeding. The aim of this study was to retrospectively evaluate the efficacy of PCCs in the surgical setting.
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Low-molecular-weight heparin-induced osteoporosis and osteoporotic fractures: A myth or an existing entity?
Long-term use of unfractioned heparin data has been associated with a 2.2–5% incidence of heparin-induced osteoporotic fracture, but for low-molecular-weight heparin (LMWH) data is scarce and there is lack of clarity of the risks of osteoporosis and osteoporotic fractures. In this paper we review the differential diagnosis of osteoporosis and osteoporotic fractures, and we conduct a systematic review of all related cases from case reports and trials.
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