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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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Anaemia-reducing drugs given to cancer patients linked to risk of DVT and PE
The anaemia-reducing medications, known as erythropoiesis-stimulating agents (i.e. erythropoietin and darbopoietin) or ESAs, stimulate red blood cell production and are intended to reduce the number of blood transfusions required during chemotherapy. However, concerns about the risks of deep vein thrombosis or pulmonary embolism (manifestations of venous thromboembolism) and mortality exist.
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Is it possible to safely administer early a loading dose of clopidogrel before coronary angiography to patients who are candidates for percutaneous coronary intervention?
Current American College of Cardiology/American Heart Association guidelines recommend loading clopidogrel >or=6 hours before percutaneous coronary intervention. Other American College of Cardiology guidelines advise withholding clopidogrel for 5 days before coronary artery bypass grafting (CABG) to avoid excessive bleeding.
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Control of Blood Clotting by Platelets Described; Provides Medical Promise
Cell fragments called platelets are essential to promote blood clotting. Virginia Tech faculty members and students have discovered novel molecular interactions at the surface of platelets that control blood clotting.
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Important Information on Changes to Heparin Potency
Health Canada is informing health care professionals and Canadians of recent changes to heparin manufacturing standards in the United States that will result in a decrease in the potency of certain heparin products by about 10 per cent.
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Clopidogrel response decreased with chronic renal failure
Chronic renal disease appears to reduce platelet responsiveness to clopidogrel, according to a Korean research team. Furthermore, increasing the dose of clopidogrel does not improve platelet responsiveness in these patients.
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Thromboprophylaxis compliance at forefront of oncology discussions
Venous thromboembolism is the second leading cause of death in patients with cancer, but compliance with routine prophylaxis remains a challenge. Studies continue to show that many at-risk patients with cancer are not receiving appropriate prophylaxis or any prophylaxis at all, even though many society guidelines call for routine prophylaxis.
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Half of all hospitalised patients at risk of Venous Thrombo Embolism
Pulmonary embolism accounts for 5-10 per cent of deaths in hospitalised patients, making VTE the most common preventable cause of in-hospital deaths. In addition to the acute risk of mortality, VTE is associated with long-term risks of post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension. These complications contribute substantially to patient morbidity and the cost of management.
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Venous thromboembolism prophylaxis and treatment in cancer: a consensus statement of major guidelines panels and call to action
There is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters.
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Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting
Early postoperative clopidogrel combined with aspirin may be safe and beneficial compared with perioperative aspirin treatment alone, in both on-pump and off-pump coronary artery bypass grafting. However, a possibility of selection bias calls for randomized controlled trials to confirm our findings
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Optimal Anticoagulation Therapy in Patients With Valvular Heart Disease or Atrial Fibrillation
As a result of this study, the authors suggest that perhaps a target INR of 3.0 should be used for AF and mechanical heart valves, while an INR of 3.5 should be achieved in those patients who have sustained a myocardial infarction.
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Post-PCI Mortality Similar With Enoxaparin or Heparin
The researchers found that mortality rates from one month to one year were similar in the both enoxaparin and the unfractionated heparin groups (1.4, 2, and 1.5 percent versus 2.3, 2.2, and 1.9 percent). They also found that the two most important risk factors for one-year morality were nonfatal myocardial infarction and/or urgent target vessel revascularization within 30 days after the intervention, and major bleeding within 48 hours of the intervention (hazard ratios, 3.5 and 3.0, respectively).
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Boehringer’s Pradaxa Matches Warfarin as Clot Therapy in Study
Just 2.4 percent of patients given Pradaxa for six months after their initial treatment developed clots in the legs and lungs, similar to the 2.2 percent rate for those given the generic drug warfarin, according to an abstract of the so-called Recover study posted on the American Society of Hematology Web site last week.
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Role of the CHADS(2) Score in the Evaluation of Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Before Pulmonary Vein Isolation
The prevalence of LA/LAA sludge/thrombus in patients with AF undergoing a pre-PVI screening TEE is very low (<2%) and increases significantly with higher CHADS(2) scores. This suggests that a screening TEE before PVI should be performed in patients with a CHADS(2) score of >/=1, and in patients with a CHADS(2) score of 0 when the AF is persistent and therapeutic anticoagulation has not been maintained for 4 weeks before the procedure.
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Positive Results From Chronic Study With Bayer's Rivaroxaban Will Be Presented As A Late Breaker At ASH 2009
The study investigated the long-term benefits of 20 mg rivaroxaban once-daily compared with placebo in the secondary prevention of recurrent symptomatic venous blood clots in approximately 1,200 patients with symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE).
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Catheter-directed therapy safe and effective for massive pulmonary embolism
Catheter-directed therapy is an effective treatment for acute massive pulmonary embolism (PE) and the risk of major complications is relatively small, the results of a systematic review and meta-analysis indicate.
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Obesity and Smoking Major Risk Factors for VTE
Smokers who consumed 1 to 14 grams of tobacco (up to 17 cigarettes) a day had a 31% increased risk of an event (P=0.006), while and smokers of 15 to 24 grams of tobacco (18 to 30 cigarettes) increased their risk of an event by 47% (P<0.001). Those who smoked more than 25 grams of tobacco a day had a 60% increased risk (P=0.001). Weight was also a major factor in risk. A BMI of less than 20 was the reference point for measurement, but up to a BMI of 25 there there was no significant difference in risk. A BMI of 25 to 30 increased risk by 27%, but not significantly (P=0.15). A BMI of 30 to 35 significantly increased risk by 67% (P=0.004), while a BMI over 35 more than doubled the risk VTE (P<0.001).
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Bayer's Xarelto pill cuts risk in long-term study
The pill, based on the active ingredient rivaroxaban, led to an 82 percent lower risk that a dangerous venous blood clot would form again, compared with a control group on placebo, according to the abstract of a study published on the Website of the American Society of Hematology (ASH) on Thursday.
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Newer Anticoagulants Beat Heparin for PCI
Schiele said 151 of the patients (17%) received no pretreatment. A second group of 177 (20%) received unfractionated heparin. He said that outcomes between these two groups were similar and failed to reach statistical difference. A third group of 270 patients (30%) received enoxaparin, and 299 (33%) were pretreated with fondaparinux. The outcomes between enoxaparin patients and fondaparinux patients were not statistically different.
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Air Pollution Link to Thrombosis Fades Away
Griffin and colleagues identified 26,400 women who entered the trials without evidence of previous venous thromboembolism. Of that group, 520 women subsequently experienced venous thromboembolic episodes. The women were enrolled in the studies from 1993 to 1998 and were followed through 2004.
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Prasugrel Incorporated into New STEMI Guidelines
A 60-milligram loading dose of prasugrel (Effient) is now a recommended alternative to clopidogrel for patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention, according to updated guidelines.
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Mobile ventricular thrombus arising from the mitral annulus in patients with dense mitral annular calcification
Mitral annular calcification (MAC) has been considered a risk factor for thrombo-embolic disease. Superimposed thrombus formation on MAC has not been well described as a possible underlying mechanism for this association. We report three patients with mobile left ventricular (LV) thrombus arising from the LV aspect of severe calcified mitral annulus in the setting of normal LV function, mitral valve function, and sinus rhythm.
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Rivaroxaban Cuts Risk of VTE in Joint Replacement
A meta-analysis of eight clinical trials involving 13,398 patients determined that a statistically significant relative risk reduction of 50.7% (95% CI 0.33 to 0.75, P=0.001) was achieved when patients received rivaroxaban rather than enoxaparin, Umesh Tamhane, MD, of the University of Michigan, reported at the annual meeting of the American Heart Association.
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VTE a Risk for Adult Survivors of Fontan Surgery
Adults who survived the life-saving, but grueling Fontan heart procedure in childhood appear to be at an increased risk of experiencing venous thromboembolic events.
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Stroke, VTE More Common with Darbepoetin
Treating patients with diabetes, kidney disease, and anemia with the colony stimulating factor darbepoetin (Aranesp) to improve their hemoglobin levels appears to cause more problems than it solves, researchers reported here.
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ThrombosisAdviser granted with the award for Pharmaceuticals Standard of Excellence
The site was recognized by WebAward judges for its innovation, design, content, interactivity and use of technology.
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Plavix Dulled by Nexium, Prilosec, Tagamet, Prozac, Other Drugs
The FDA today warned patients not to combine Plavix with Nexium, Prilosec, and nine other drugs -- including Prozac and Tagamet.
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A Computerized Handheld Decision-Support System to Improve Pulmonary Embolism Diagnosis
The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023).
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Aspirin without Plavix as good after heart bypass
Aspirin alone proved as effective as aspirin plus the blood clot preventer Plavix in keeping coronary artery bypass grafts open during the first year after surgery, according to a study released on Monday.
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New warnings added to Plavix (clopidogrel) label
Several new warnings have been added to the Plavix (clopidogrel) label. The new warnings are for reduced effectiveness due to impaired CYP2C19 function and for co-adminstration of the drug with omeprazole, which can reduce the pharmacologic activity of clopidogrel. The label changes took place on November 12 according to the drug’s approval history on the FDA website.
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Differences in Clinical Outcomes with Rhythm-and Rate-Control Therapies for Atrial Fibrillation in the Record-AF Registry
It is important to note that this registry study, similar to clinical trials comparing treatment strategies, is a study of primarily older patients. It is interesting to note that high occurrence of CV events (18%) and mortality rate (3%) was observed at one year for both rate-control and rhythm-control strategies. The increased rate of MACE may be due to lack of anticoagulation (only 60% use of oral vitamin K antagonist in patients with CHAD2 score > 2).
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Assays Help Predict Risk of Adverse Outcomes After PCI
Three tests of platelet reactivity were able to predict which patients undergoing an elective percutaneous coronary intervention (PCI) would have a thrombotic event within one year, despite antiplatelet therapy, researchers reported here...Up to 36% of patients are resistant to clopidogrel, ten Berg said, which increases the risk for thrombotic complications following PCI.
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PLATO: Ticagrelor decreased mortality from CV, MI, stroke in patients with STEMI
Patients were randomly assigned for one year to ticagrelor 180 mg loading-dose followed by 90 mg twice-daily (n= 4,201) or clopidogrel 300 mg loading-dose followed by 75 mg once-daily (n= 4,229). All patients were assigned to 325 mg aspirin daily. An additional dose of ticagrelor was assigned at the time of randomization for patients who underwent PCI. Follow-up visits were at one, three, six, nine and 12 months.
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Relevance of D-dimer Testing in Patients with Venous Malformations
Elevated D-dimer levels appear to correlate with patient morbidity and in particular with painful episodes of intravascular clot formation. One potentially life-threatening albeit rare complication of KTS or VMs is pulmonary emboli in the setting of chronic clotting, either as an acute event or chronic process, which can lead to chronic thromboembolic pulmonary hypertension.
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AHA: Rivaroxaban Drops Pro-Coagulation Factor in HF Patients
Over the course of a week, levels of prothrombin fragment 1.2 increased by 11.6 ng/ml among placebo patients with severe heart failure (New York Heart Association Class III/IV). Among patients on rivaroxaban, prothrombin fragment 1.2 actually decreased 2.7 ng/ml, indicating a significant reversal of the level (P=0.0009).
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EXPIRA: Thrombectomy plus PCI linked with ST-segment resolution, improved myocardial blush grade
Patients treated with thrombectomy plus percutaneous coronary intervention were more likely to have ST-segment resolution and improve myocardial blush grade than those receiving standard PCI alone.
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Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition– PCI (CHAMPION PCI — Presented at AHA 2009)
Among patients undergoing PCI, the use of cangrelor was not superior to clopidogrel; however, efficacy and safety outcomes appeared to be similar. Cangrelor did not reduce the outcome of death, MI, or urgent revascularization at 48 hours. Significant bleeding was similar between the two treatment arms except for a marginal increase in ACUITY major bleeding.
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Effient(R) Exhibited Greater Antiplatelet Activity than High Dose Clopidogrel in Type 2 Diabetes Mellitus Patients with Coronary Artery Disease
Results from a new study showed patients with type 2 diabetes mellitus who also had coronary artery disease (CAD) and received a 60 mg loading dose and 10 mg maintenance dose of Effient® (prasugrel) achieved significantly greater platelet inhibition compared with a 600 mg loading dose and 150 mg maintenance dose of Plavix® (clopidogrel).
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Randomized Evaluation of Long-Term Anticoagulant Therapy Warfarin, Compared With Dabigatran (RE–LY — Presented at AHA 2009)
Results were similar for all-cause mortality: warfarin 4.13%/year, dabigatran 150 mg group 3.64%/year (RR 0.88, 95% CI 0.77-1.00, p = 0.051), dabigatran 110 mg 3.75%/year, (RR 0.91, 95% CI 0.80-1.03, p = 0.13).
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Skin Lesions Can Appear Following Heparin Treatment
According to the press release announcing the findings, skin lesions caused by heparin may indicate the presence of a life-threatening decrease in the number of platelets—a condition called “heparin-induced thrombocytopenia”—or an allergic skin reaction.
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2008 SOR guidelines for the prevention and treatment of thrombosis associated with central venous catheters in patients with cancer: report from the working group
Several rigorous studies do not support the use of anticoagulants for the prevention of CVC-associated thrombosis. Treatment of CVC-associated thrombosis relies on the same principles as those applied in the treatment of established thrombosis in cancer patients.
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New Standards Reduce Heparin Potency
Clinicians should be aware of new manufacturing controls that have decreased the potency of the anticlotting agent heparin by up to 10%, according to the US Food and Drug Administration (FDA).
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When Seconds Count: Interventional Radiology Treatment for Pulmonary Embolism Saves Lives
Catheter-directed Therapy Should Be Considered a First-line Treatment Option for Massive Blood Clots in the Lungs, According to Study of Nearly 600 Patients in Journal of Vascular and Interventional Radiology
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Incidence and Risk Factors of Early Thromboembolic Events After Mechanical Heart Valve Replacement in Patients Treated With Intravenous Unfractionated Heparin
Despite the use of IVUH, the rate of early TE after mechanical mitral valve replacement remained relatively high. These results suggest that early effective anticoagulation is required after mitral mechanical heart valve, since inappropriate anticoagulation on day 3 was significantly associated with early TE.Despite the use of IVUH, the rate of early TE after mechanical mitral valve replacement remained relatively high. These results suggest that early effective anticoagulation is required after mitral mechanical heart valve, since inappropriate anticoagulation on day 3 was significantly associated with early TE.
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ESAs associated with increased risk for VTE but not mortality
From diagnosis to the end of follow-up, 11% of 47,342 patients were newly diagnosed with venous thromboembolism. Among patients who received ESAs, 14.3% experienced venous thromboembolism compared with only 9.8% of patients who did not received ESAs. Patients with five or more claims for ESAs were more likely to experience venous thromboembolism (HR=1.55; 95% CI, 1.44-1.66) than those with fewer claims (HR=1.31; 95% CI, 1.19-1.44).
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The Relative Efficacy and Safety of Clopidogrel in Women and Men
Overall, clopidogrel was associated with a highly significant 14% proportional reduction in the risk of cardiovascular events (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.80 to 0.93), with no significant differences in treatment effect between women and men.
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Journal of Cardiovascular Nursing Urges Policies and Prevention To Reduce Deaths from Venous Thromboembolism
"VTE is a major but often unrecognized cause of morbidity and mortality in hospitalized patients," said Barbara Riegel, DNSc, RN, FAAN, Editor of the Journal of Cardiovascular Nursing and University of Pennsylvania School of Nursing Professor. "Articles in our supplement call for better adherence to current treatment guidelines and hospital-wide education to better prevent and treat deep vein thrombosis and pulmonary embolism."
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Sleep apnea linked to venous thromboembolism
The rates of pulmonary embolism, deep vein thrombosis, and VTE were 1.03%, 1.17%, and 1.94%, respectively. Women with sleep disordered breathing had higher rates of pulmonary embolism and VTE than did men, while men had a higher rate of deep vein thrombosis.
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VTE Prophylaxis Compliance Lacking
The study reported that, overall, 65.9% of medical discharges and 77.7% of surgical discharges received at least one order for VTE prophylaxis during hospitalization. However, when ACCP guidelines for type, dose, and duration are overlaid on the same data set, the percentage of "appropriate prophylaxis" dropped to 16.4% for medical discharges and 12.7% for surgical discharges.
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Studies in the area of thromboembolism reported from A. Patel and co-researchers
"We performed a retrospective review of all patients undergoing induction therapy before lung resection for non-small cell lung cancer and malignant pleural mesothelioma at the University Health Network between January 1996 and December 2007."
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VTE: A Major Public Health Problem Comes To The Fore
Pulmonary embolism is now believed to be the foremost preventable cause of in-hospital mortality, as well as the leading cause of maternal mortality in the United States. The incidence of VTE has been variably estimated at anywhere between 200,000 and 900,000 cases per year in this country, accounting for 60,000 to 300,000 deaths.
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Blood Clots Near the Skin Linked to Deeper and Deadlier Clotting
They found that 24 percent of participants in their study, all of whom had SVT, tested positive for DVT, most typically within the same limb showing SVT symptoms. According to Dr. Barbara Binder, one of the study’s authors, "The results of this study indicate that concurrent deep vein thrombosis is more likely when superficial vein thrombosis affects the lower leg."
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NICE Guidance Recommends Option For Preventing Arterial Blood Clots In People With Acute Coronary Syndromes
The guidance recommends prasugrel in combination with aspirin as an option for individuals who are having percutaneous coronary intervention, only when: immediate primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction (a specific type of heart attack) is necessary or a blood clot blocking a stent has occurred during treatment with a drug called clopidogrel or the patient has diabetes mellitus.People currently receiving prasugrel for treatment of acute coronary syndromes whose circumstances do not meet these criteria should have the option to continue therapy until they and their clinicians consider it appropriate to stop.
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Vena cava filter occlusion and venous thromboembolism risk in persistently anticoagulated patients: A prospective, observational cohort study
If therapeutic anticoagulation can be safely begun in patients with IVC filters inserted after venous thromboembolism, further management with clinical surveillance, including ultrasound examination of the IVC filter and graded degrees of anticoagulation therapy if filter clot is detected, has a favorable prognosis. This approach appears valid for current IVC filter patients and can serve as a comparison standard in subsequent clinical trials to optimize clinical management of these patients.
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Statins may prevent blood clots in patients with cardiovascular disease
Results of the analysis showed that patients in the nonstatin group were three times as likely to develop VTE than patients receiving statins, 26.3 percent vs. 8.3 percent, respectively. Even after controlling for factors related to VTE (smoking, history of cancer, and immobilization), statins use was still associated with a low risk of developing VTE. Furthermore, patients receiving high-dose statins (greater than 40 mg/day) showed a lower occurrence of VTE compared with patients receiving standard dose statins, suggesting a dose-related response between statins and VTE.
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Thromboprophylaxis in Patients with Acute Spinal Injuries: An Evidence-Based Analysis
The prevalence of deep-vein thrombosis following a spine injury is higher among patients who have a spinal cord injury than among those who do not have a spinal cord injury. Therefore, thromboprophylaxis in these patients should start as early as possible once it is deemed safe in terms of potential bleeding complications.
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Venous Thromboembolism Prophylaxis on Inpatient Psychiatry Unit
The purpose of the present case was to heighten awareness of venous thromboembolism among inpatient psychiatrists who care for older patients with organic mental diseases or patients with general medical comorbidities. Psychiatric inpatients demonstrating restricted mobility and who have at least one venous thromboembolism risk factor and lack contraindications for prophylaxis should be reviewed for prophylaxis.
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Warfarin given at therapeutic INR during pulmonary vein isolation yielded no additional bleeding complications
“Based on data from a patient population of more than 3,000 patients, continuation of [warfarin] at a therapeutic INR level at the time of radiofrequency ablation without use of heparin or enoxaparin for bridging before or after ablation is a safe and efficacious periprocedural anticoagulation strategy,” the researchers wrote. “It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.”
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Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country
A significant risk for DVT and PE exists in medically ill patients, but only a small proportion of the patients are given prophylaxis. This study underlines the need to aggressively implement DVT risk stratification strategy in medical patients and provide prophylaxis unless contraindicated.
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Pulmonary Embolism and Deep Venous Thrombosis in Trauma: Are They Related?
The authors concluded that few patients with PE have a documented DVT of the pelvic or proximal lower extremity veins, challenging the dogma that most PE originates from these veins. They suggested that many of these PEs may occur de novo in the lungs. The authors concluded by suggesting that their findings have implications for the value of vena cava filters in trauma patients.
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Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: a review
In high-risk surgical and medical patients, the risk of VTE may extend beyond the period of hospitalization. Such patients may benefit from extended-duration thromboprophylaxis to reduce the risk of late VTE events. LMWHs were efficacious, were associated with low rates of clinically relevant bleeding complications, and were cost-effective in patients at high risk for VTE.
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