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Dominique Farge, Henri Bounameaux, Benjamin Brenner, Francis Cajfinger, Philippe Debourdeau, Alok A Khorana, Ingrid Pabinger, Susan Solymoss, James Douketis, Ajay Kakkar
Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis...
October 2016: Lancet Oncology
James Douketis, Sam Schulman, Summer Syed
No abstract text is available yet for this article.
September 22, 2016: Regional Anesthesia and Pain Medicine
Benjamin R Bell, Alex C Spyropoulos, James D Douketis
The periprocedural management of patients on direct oral anticoagulants (DOACs) is a common but potentially challenging clinical problem because there are few prospective studies to guide clinical decisions. Retrospective analyses from randomized trials and observational data suggest that DOACs can be managed in a standardized manner, based on surgical and patient characteristics, that does not result in excess major bleeding or thrombosis. In a case-based manner, this article presents a perioperative DOAC management algorithm and reviews the available and emerging evidence supporting the safety and efficacy of this approach...
October 2016: Hematology/oncology Clinics of North America
John W Eikelboom, Clive Kearon, Gordon Guyatt, Daniel I Sessler, Salim Yusuf, Deborah Cook, James Douketis, Ameen Patel, Andrea Kurz, Rene Allard, Philip M Jones, Rodolfo J Dennis, Thomas W Painter, Sergio D Bergese, Kate Leslie, Duminda N Wijeysundera, Kumar Balasubramanian, Emmanuelle Duceppe, Scott Miller, Johan Diedericks, P J Devereaux
BACKGROUND: The PeriOperative ISchemia Evaluation-2 (POISE-2) trial compared aspirin with placebo after noncardiac surgery. METHODS: The authors randomly assigned 10,010 patients undergoing noncardiac surgery to receive 200 mg aspirin or placebo 2 to 4 h before surgery and then 100 mg aspirin daily or placebo daily for up to 30 days after surgery. Herein, the authors report the effect of aspirin on venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, as well as an updated pooled analysis of randomized trials of antiplatelet therapy for VTE prevention in noncardiac surgery patients...
September 14, 2016: Anesthesiology
C Kearon, S Parpia, F A Spencer, T Baglin, S M Stevens, K A Bauer, S R Lentz, C M Kessler, J D Douketis, S Moll, S Kaatz, S Schulman, J M Connors, J S Ginsberg, L Spadafora, P Liaw, J I Weitz, J A Julian
BACKGROUND: The rate of recurrent venous thromboembolism (VTE) in patients with a first unprovoked VTE who had a negative qualitative D-dimer test one month after stopping anticoagulant therapy was higher than expected in the D-dimer Optimal Duration Study (DODS). OBJECTIVES: To determine whether quantitative D-dimer levels using a low threshold, age- and sex-specific thresholds, or repeated measurements, would improve identification of patients at low risk of recurrent VTE...
June 23, 2016: Thrombosis Research
Aaron Liew, James Douketis
No abstract text is available yet for this article.
May 23, 2016: Internal and Emergency Medicine
A C Spyropoulos, A Al-Badri, M W Sherwood, J D Douketis
The periprocedural management of patients receiving chronic therapy with oral anticoagulants (OACs), including vitamin K antagonists (VKAs) such as warfarin and direct OACs (DOACs), is a common clinical problem. The optimal perioperative management of patients receiving chronic OAC therapy is anchored on four key principles: (i) risk stratification of patient-related and procedure-related risks of thrombosis and bleeding; (ii) the clinical consequences of a thrombotic or bleeding event; (iii) discontinuation and reinitiation of OAC therapy on the basis of the pharmacokinetic properties of each agent; and (iv) whether aggressive management such as the use of periprocedural heparin bridging has advantages for the prevention of postoperative thromboembolism at the cost of a possible increase in bleeding risk...
May 2016: Journal of Thrombosis and Haemostasis: JTH
Geoffrey D Barnes, James D Douketis
No abstract text is available yet for this article.
March 15, 2016: Annals of Internal Medicine
James D Douketis, Jeff S Healey, Martina Brueckmann, Mandy Fraessdorf, Alex C Spyropoulos, Lars Wallentin, Jonas Oldgren, Paul Reilly, Michael D Ezekowitz, Stuart J Connolly, Salim Yusuf, John W Eikelboom
BACKGROUND: There is concern about the management of anticoagulated patients with atrial fibrillation (AF) who require an urgent surgery/procedure, especially in those who are receiving a direct oral anticoagulant such as dabigatran. METHODS: We accessed the database from RE-LY, a randomized trial comparing dabigatran (110mg and 150mg twice daily) with warfarin for stroke prevention in AF, to assess patients who had an urgent and elective surgery/procedure. We compared the risk for thromboembolism, major bleeding and mortality according to treatment allocation (dabigatran 110mg or 150mg, or warfarin) or surgery/procedure type (urgent or elective)...
March 2016: Thrombosis Research
James D Douketis, Summer Syed, Sam Schulman
No abstract text is available yet for this article.
March 2016: Regional Anesthesia and Pain Medicine
Ryma Ihaddadene, Daniel J Corsi, Alejandro Lazo-Langner, Sudeep Shivakumar, Ryan Zarychanski, Vicky Tagalakis, Susan Solymoss, Nathalie Routhier, James Douketis, Gregoire Le Gal, Marc Carrier
Risk factors predictive of occult cancer detection in patients with a first unprovoked symptomatic venous thromboembolism (VTE) are unknown. Cox proportional hazard models and multivariate analyses were performed to assess the effect of specific risk factors on occult cancer detection within 1 year of a diagnosis of unprovoked VTE in patients randomized in the Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) trial. A total of 33 (3.9%; 95% CI, 2.8%-5.4%) out of the 854 included patients received a new diagnosis of cancer at 1-year follow-up...
April 21, 2016: Blood
Scott M Stevens, Scott C Woller, Kenneth A Bauer, Raj Kasthuri, Mary Cushman, Michael Streiff, Wendy Lim, James D Douketis
Thrombophilias are hereditary and/or acquired conditions that predispose patients to thrombosis. Testing for thrombophilia is commonly performed in patients with venous thrombosis and their relatives; however such testing usually does not provide information that impacts management and may result in harm. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance for thrombophilia testing in five clinical situations: following 1) provoked venous thromboembolism, 2) unprovoked venous thromboembolism; 3) in relatives of patients with thrombosis, 4) in female relatives of patients with thrombosis considering estrogen use; and 5) in female relatives of patients with thrombosis who are considering pregnancy...
January 2016: Journal of Thrombosis and Thrombolysis
John Agzarian, Waël C Hanna, Laura Schneider, Colin Schieman, Christian J Finley, Yury Peysakhovich, Terri Schnurr, Dennis Nguyen-Do, Lori-Ann Linkins, James Douketis, Mark Crowther, Marc De Perrot, Thomas K Waddell, Yaron Shargall
OBJECTIVES: To determine the prevalence of delayed postoperative venous thromboembolism (VTE) in patients undergoing oncologic lung resections, despite adherence to current in-hospital VTE prophylaxis guidelines. METHODS: Patients undergoing lung resection for malignancy in 2 tertiary-care centers were recruited between June 2013 and December 2014. All patients received guideline-based VTE prophylaxis until hospital discharge. Patients underwent computed tomography chest angiography with pulmonary embolism (PE) protocol and bilateral lower extremity venous Doppler ultrasonography at 30 ± 5 days after surgery to determine the incidence of postoperative VTE...
April 2016: Journal of Thoracic and Cardiovascular Surgery
S M Bates, S Takach Lapner, J D Douketis, C Kearon, J Julian, S Parpia, S Schulman, J I Weitz, L A Linkins, M Crowther, W Lim, F A Spencer, A Y Y Lee, P L Gross, J Ginsberg
UNLABELLED: ESSENTIALS: It is not known if D-dimer testing alone can safely exclude pulmonary embolism (PE). We studied the safety of using a quantitative latex agglutination D-dimer to exclude PE in 808 patients. 52% of patients with suspected PE had a negative D-dimer test and were followed for 3 months. The negative predictive value of D-dimer testing alone was 99.8%, suggesting it may safely exclude PE. SUMMARY: HASH(0x45ae060) BACKGROUND: Strategies are needed to exclude pulmonary embolism (PE) efficiently without the need for imaging tests...
March 2016: Journal of Thrombosis and Haemostasis: JTH
Walter Ageno, Giuseppe Camporese, Nicoletta Riva, Matteo Iotti, Eugenio Bucherini, Marc Righini, Pieter W Kamphuisen, Peter Verhamme, James D Douketis, Chiara Tonello, Paolo Prandoni
BACKGROUND: Compression ultrasonography is the mainstay of diagnosis of deep-vein thrombosis (DVT) of the legs. Compression ultrasonography can be extended to the entire deep venous system (whole-leg) or restricted to the proximal veins only (limited), and the two approaches are clinically equivalent. We aimed to assess the diagnostic value of an algorithm combining whole-leg and limited compression ultrasonography. METHODS: We did a prospective, multicentre, cohort study at eight centres in five countries...
November 2015: Lancet Haematology
Aaron Liew, James Douketis
In patients with extensive lower limb deep vein thrombosis (DVT) that, typically, extends into the iliofemoral veins, catheter-directed thrombolysis (CDT) can achieve faster and more complete thrombus lysis as compared with systemic thrombolysis, while providing an acceptable safety profile through administration of lower doses of thrombolytic agents. Through a reduction in thrombus burden, CDT has the potential to mitigate the risk for post-thrombotic syndrome by restoring venous patency and preserving venous valve function...
2016: Expert Review of Cardiovascular Therapy
J D Douketis, G Wang, N Chan, J W Eikelboom, S Syed, R Barty, K A Moffat, F A Spencer, M Blostein, S Schulman
UNLABELLED: ESSENTIALS: Anticoagulants need to be stopped preprocedure so there is little or no remaining anticoagulant effect. We assessed the residual anticoagulant effect with standardized interruption for patients on dabigatran. With this protocol, 80-86% of patients had no residual anticoagulant effect at the time of a procedure. A standardized perioperative dabigatran protocol appears to be safe, but requires further study. BACKGROUND: In patients taking dabigatran who require treatment interruption for a surgery/procedure, a sufficient interruption interval is needed so that there is little or no residual anticoagulant effect at the time of the surgery/procedure...
January 2016: Journal of Thrombosis and Haemostasis: JTH
Alfonso Tafur, James D Douketis
Defining the safest perioperative anticoagulation management approach for patients who are receiving chronic anticoagulant therapy stroke prevention has been a challenging and longstanding dilemma, especially for patients with atrial fibrillation who constitute the most common patient group receiving long term anticoagulation. Using a case-based format, we summarize the findings of recent clinical trialswhich have helped to informed best practices for perioperative anticoagulant management in patients with atrial fibrillation and provide an algorithmic management approach to this problem...
2015: Polskie Archiwum Medycyny Wewnętrznej
David Lillicrap, Jim Douketis
No abstract text is available yet for this article.
June 2015: Journal of Thrombosis and Haemostasis: JTH
David J Gladstone, William H Geerts, James Douketis, Noah Ivers, Jeff S Healey, Kori Leblanc
No abstract text is available yet for this article.
September 1, 2015: Annals of Internal Medicine
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