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PE prevention in bleeding

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https://www.readbyqxmd.com/read/28450810/reduced-cardiac-function-and-risk-of-venous-thromboembolism-in-asian-countries
#1
REVIEW
Ruiqi Zhu, Yu Hu, Liang Tang
Patients with reduced cardiac function are thought to have a higher risk of venous thromboembolism (VTE). Additionally, they are vulnerable to complications of pulmonary embolism (PE) as well as right heart failure (HF), which in return is supposed to increase the rate of mortality. Studies focusing on VTE in heart failure patients were rare in Asian countries before the 21st century. Nowadays, more and more data are becoming available in this field in Asia. It is already known that heart failure can increase the risk of VTE, but so far a consensus on this issue has not been reached for many years, not only in Asian countries but all over the world...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28265129/deep-vein-thrombosis-interventions-in-cancer-patients
#2
REVIEW
Resmi Ann Charalel, Suresh Vedantham
The presence of cancer increases the risk of deep vein thrombosis (DVT), DVT recurrence, and treatment-related bleeding, and therefore offers distinctive clinical considerations when planning treatment. Anticoagulation with a low-molecular-weight heparin is the preferred initial and long-term therapy in cancer patients. Inferior vena cava filters may be used judiciously for patients with cancer-related DVT who have contraindications to anticoagulation or who exhibit breakthrough pulmonary embolism (PE) despite anticoagulation, but should be removed when the PE risk is felt to subside...
March 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/28195640/subcutaneous-unfractionated-heparin-for-the-initial-treatment-of-venous-thromboembolism
#3
REVIEW
Lindsay Robertson, James Strachan
BACKGROUND: Venous thromboembolism (VTE) is a prevalent and serious condition. Its medical treatment requires anticoagulation, usually with either unfractionated or low molecular weight heparin (LMWH). Administration of unfractionated heparin (UFH) is usually intravenous (IV) but can be subcutaneous as well. This is an update of a review first published in 2009. OBJECTIVES: To assess the effects of subcutaneous UFH versus intravenous UFH, subcutaneous LMWH or any other anticoagulant drug for the initial treatment of venous thromboembolism...
February 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28101125/preventive-transarterial-embolization-in-upper-nonvariceal-gastrointestinal-bleeding
#4
Aleksejs Kaminskis, Aina Kratovska, Sanita Ponomarjova, Anna Tolstova, Maksims Mukans, Solvita Stabiņa, Raivis Gailums, Andrejs Bernšteins, Patricija Ivanova, Viesturs Boka, Guntars Pupelis
BACKGROUND: Transarterial embolization (TAE) is a therapeutic option for patients with a high risk of recurrent bleeding after endoscopic haemostasis. The aim of our prospective study was a preliminary assessment of the safety, efficacy, and clinical outcomes following preventive TAE in patients with non-variceal acute upper gastrointestinal bleeding (NVUGIB) with a high risk of recurrent bleeding after endoscopic haemostasis. METHODS: Preventive visceral angiography and TAE were performed after endoscopic haemostasis on patients with NVUGIB who were at a high risk of recurrent bleeding (PE+ group)...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28092428/reproducibility-of-clinical-events-adjudications-in-a-trial-of-venous-thromboembolism-prevention
#5
P Girard, A Penaloza, F Parent, B Gable, O Sanchez, P Durieux, P Hausfater, S Dambrine, G Meyer, P-M Roy
Essentials The reproducibility of Clinical Events Committee (CEC) adjudications is almost unexplored. A random selection of events from a venous thromboembolism trial was blindly re-adjudicated. 'Unexplained sudden deaths' (possible fatal embolism) explained most discordant adjudications. A precise definition for CEC adjudication of this type of events is needed and proposed. SUMMARY: Background When clinical trials use clinical endpoints, establishing independent Clinical Events Committees (CECs) is recommended to homogenize the interpretation of investigators' data...
April 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28078350/efficacy-and-safety-of-extended-thromboprophylaxis-for-medically-ill-patients-a-meta-analysis-of-randomised-controlled-trials
#6
Francesco Dentali, Nicola Mumoli, Domenico Prisco, Andrea Fontanella, Matteo Nicola Dario Di Minno
Compelling evidence suggests that the risk of pulmonary embolism (PE) and deep-vein thrombosis (DVT) persists after hospital discharge in acutely-ill medical patients. However, no studies consistently supported the routine use of extended-duration thromboprophylaxis (ET) in this setting. We performed a meta-analysis to assess efficacy and safety of ET in acutely-ill medical patients. Efficacy outcome was defined by the prevention of symptomatic DVT, PE, venous thromboembolism (VTE) and VTE-related mortality...
February 28, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27979674/a-treatment-strategy-using-subcutaneous-fondaparinux-followed-by-oral-rivaroxaban-is-effective-for-treating-acute-venous-thromboembolism
#7
Takayuki Kabuki, Rine Nakanishi, Shinji Hisatake, Takahiro Fujii, Shintaro Dobashi, Shingo Wakakura, Shunsuke Kiuchi, Tadashi Fujino, Takanori Ikeda
BACKGROUND: The factor Xa inhibitors have been widely used for the treatment and prevention of venous thromboembolism (VTE). However, the efficacy of factor Xa inhibitors in Japanese patients with VTE has not been well examined. In this study, we investigated the effect of the sequential use of two factor Xa inhibitors in patients with acute VTE. METHODS: We conducted an observational study of 87 consecutive patients diagnosed with VTE. As an initial treatment, we administered subcutaneous fondaparinux to the patients for 7-10 days, and then switched to oral rivaroxaban...
December 12, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27917690/pharmacological-management-of-pulmonary-embolism
#8
REVIEW
Bobby Gouin, Helia Robert-Ebadi, Marc Righini, Marc Blondon
Pulmonary embolism (PE) is a common and potentially severe manifestation of venous thromboembolism. Its management has relied on anticoagulation by vitamin K antagonists (VKA) for the past fifty years. Recently, new alternative drugs have been developed and dramatically modified both the treatment of acute PE and its secondary prevention. Areas covered: This review discusses the contemporary pharmacological treatment for PE, with a focus on anticoagulation options for non-high risk PE. In particular, the advent of direct oral anticoagulants (rivaroxaban, apixaban, edoxaban and dabigatran) and modalities for long-term prevention will be described...
January 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27843040/a-phase-iv-study-of-thromboembolic-and-bleeding-events-following-hip-and-knee-arthroplasty-using-oral-factor-xa-inhibitor
#9
David Gomez, Helen Razmjou, Andrea Donovan, Vikas B Bansal, Jeffrey D Gollish, John J Murnaghan
BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012...
October 4, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27797404/pentasaccharides-for-the-prevention-of-venous-thromboembolism
#10
REVIEW
Kezhou Dong, Yanzhi Song, Xiaodong Li, Jie Ding, Zhiyong Gao, Daopei Lu, Yimin Zhu
BACKGROUND: Venous thromboembolism (VTE) is a common condition with potentially serious and life-threatening consequences. The standard method of thromboprophylaxis uses an anticoagulant such as low molecular weight heparin (LMWH) or warfarin. In recent years, another type of anticoagulant, pentasaccharide, an indirect factor Xa inhibitor, has shown good anticoagulative effect in clinical trials. Three types of pentasaccharides are available: short-acting fondaparinux, long-acting idraparinux and idrabiotaparinux...
October 31, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27777435/a-phase-ii-clinical-trial-of-the-efficacy-and-safety-of-short-term-3-days-enoxaparin-for-the-prevention-of-venous-thromboembolism-after-gastric-cancer-surgery
#11
Shinji Kuroda, Satoru Kikuchi, Masahiko Nishizaki, Shunsuke Kagawa, Shiro Hinotsu, Toshiyoshi Fujiwara
Although intermittent pneumatic compression (IPC) has become common as perioperative prophylaxis for venous thromboembolism (VTE) consisting of pulmonary thromboembolism (PE) and deep vein thrombosis (DVT), the prophylactic effect against VTE, especially lethal PE, is not yet satisfactory. Therefore, pharmacologic prophylaxis, such as with enoxaparin, is desirable. While the efficacy and safety of enoxaparin have been proven in several clinical trials, concern about bleeding with longterm (at least 7 days) use have potentially decreased its widespread adoption...
October 2016: Acta Medica Okayama
https://www.readbyqxmd.com/read/27766049/management-of-venous-thromboembolism-an-update
#12
REVIEW
Siavash Piran, Sam Schulman
Venous thromboembolism (VTE), which constitutes pulmonary embolism and deep vein thrombosis, is a common disorder associated with significant morbidity and mortality. Landmark trials have shown that direct oral anticoagulants (DOACs) are as effective as conventional anticoagulation with vitamin K antagonists (VKA) in prevention of VTE recurrence and associated with less bleeding. This has paved the way for the recently published guidelines to change their recommendations in favor of DOACs in acute and long-term treatment of VTE in patients without cancer...
2016: Thrombosis Journal
https://www.readbyqxmd.com/read/27600864/combined-intermittent-pneumatic-leg-compression-and-pharmacological-prophylaxis-for-prevention-of-venous-thromboembolism
#13
REVIEW
Stavros K Kakkos, Joseph A Caprini, George Geroulakos, Andrew N Nicolaides, Gerard Stansby, Daniel J Reddy, Ioannis Ntouvas
BACKGROUND: It is generally assumed by practitioners and guideline authors that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. This is an update of the review first published in 2008. OBJECTIVES: The aim of this review was to assess the efficacy of combined intermittent pneumatic leg compression (IPC) and pharmacological prophylaxis versus single modalities in preventing venous thromboembolism...
September 7, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27580310/efficacy-and-safety-of-rivaroxaban-thromboprophylaxis-after-arthroplasty-of-the-hip-or-knee-retrospective-cohort-study
#14
L Loganathan, A Hua, S Patel, C Gibbons, M P Vizcaychipi
Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westminster Hospital (CWH; London, UK) advises enoxaparin given after surgery in the inpatient setting followed by rivaroxaban upon hospital discharge. This retrospective study investigated the efficacy and safety of rivaroxaban in this novel, modified venous-prophylaxis regimen in a surgical orthopaedic cohort at CWH...
September 2016: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27411591/treatment-of-acute-pulmonary-embolism-with-dabigatran-versus-warfarin-a-pooled-analysis-of-data-from-re-cover-and-re-cover-ii
#15
Samuel Z Goldhaber, Sebastian Schellong, Ajay Kakkar, Henry Eriksson, Martin Feuring, Joerg Kreuzer, Mandy Fraessdorf, Sam Schulman
Dabigatran was non-inferior to warfarin for prevention of recurrent venous thromboembolism (VTE), and dabigatran had a lower rate of bleeding compared with warfarin in two large-scale randomised trials, RE-COVER and RE-COVER II. In this study, we investigate the efficacy and safety of dabigatran versus warfarin according to the index event that qualified the patient for enrollment, either symptomatic pulmonary embolism (PE) with or without deep-vein thrombosis (DVT), or DVT alone. We then analyse the anticoagulant effect of dabigatran vs warfarin on patients enrolled with PE...
September 27, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27299709/edoxaban-exposure-response-analysis-and-clinical-utility-index-assessment-in-patients-with-symptomatic-deep-vein-thrombosis-or-pulmonary-embolism
#16
J Nyberg, K E Karlsson, S Jönsson, Oqp Yin, R Miller, M O Karlsson, Ush Simonsson
Edoxaban exposure-response relationships from the phase III study evaluating edoxaban for prevention and treatment of venous thromboembolism (VTE) in patients with acute deep vein thrombosis (DVT) and/or pulmonary embolism (PE) were assessed by parametric time-to-event analysis. Statistical significant exposure-response relationships were recurrent VTE with hazard ratio (HR) based on average edoxaban concentration at steady state (Cav) (HRCav) = 0.98 (i.e., change in the HR with every 1 ng/mL increase of Cav); the composite of recurrent DVT and nonfatal PE with HRCav = 0...
April 2016: CPT: Pharmacometrics & Systems Pharmacology
https://www.readbyqxmd.com/read/27262225/long-term-anticoagulation-with-rivaroxaban-for-preventing-recurrent-vte-a-benefit-risk-analysis-of-einstein-extension
#17
RANDOMIZED CONTROLLED TRIAL
Philip S Wells, Martin H Prins, Bennett Levitan, Jan Beyer-Westendorf, Timothy A Brighton, Henri Bounameaux, Alexander T Cohen, Bruce L Davidson, Paolo Prandoni, Gary E Raskob, Zhong Yuan, Eva G Katz, Martin Gebel, Anthonie W A Lensing
BACKGROUND: Short-term anticoagulant treatment for acute DVT or pulmonary embolism (PE) effectively reduces the risk of recurrent disease during the first 6 to 12 months of therapy. Continued anticoagulation often is not instituted because of the perception among physicians that the risk of major bleeding will outweigh the risk of new venous thrombotic episodes. METHODS: The authors performed a benefit-risk analysis by using the randomized EINSTEIN-Extension trial, which compared continued rivaroxaban with placebo in 1,197 patients with symptomatic DVT or PE who had completed 6 to 12 months of anticoagulation and in whom physicians had equipoise with respect to the need for continued anticoagulation...
November 2016: Chest
https://www.readbyqxmd.com/read/27246450/apixaban-versus-enoxaparin-in-the-prevention-of-venous-thromboembolism-following-total-knee-arthroplasty-a-single-centre-single-surgeon-retrospective-analysis
#18
D A L King, R E Pow, D M Dickison, P R Vale
BACKGROUND: There is a high risk of developing venous thromboembolism (VTE) following total knee arthroplasty (TKA). Conventional thromboprophylactic agents have limitations, such as route of administration, the need for monitoring, narrow therapeutic windows and interactions. Apixaban is a new oral anticoagulant with the potential to overcome these limitations. AIMS: To report the efficacy and safety of apixaban and low-molecular-weight heparin, enoxaparin, in VTE prophylaxis following TKA...
September 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/27027384/anticoagulants-extended-duration-for-prevention-of-venous-thromboembolism-following-total-hip-or-knee-replacement-or-hip-fracture-repair
#19
REVIEW
Rachel Forster, Marlene Stewart
BACKGROUND: The optimal duration of thromboprophylaxis after total hip or knee replacement, or hip fracture repair remains controversial. It is common practice to administer prophylaxis using low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) until discharge from hospital, usually seven to 14 days after surgery. International guidelines recommend extending thromboprophylaxis for up to 35 days following major orthopaedic surgery but the recommendation is weak due to moderate quality evidence...
March 30, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26873584/incidence-of-venous-thromboembolism-and-hemorrhage-related-safety-studies-of-preoperative-anticoagulation-therapy-in-hip-fracture-patients-undergoing-surgical-treatment-a-case-control-study
#20
Zhongdi Liu, Na Han, Hailin Xu, Zhongguo Fu, Dianying Zhang, Tianbing Wang, Baoguo Jiang
BACKGROUND: Venous thromboembolism is a common postoperative complication following orthopedic surgeries, with morbid and potentially fatal consequences. Perioperative low-molecular-weight heparin (LMWH) therapy can reduce the incidence of venous thromboembolism, but may also increase the risk of bleeding complications. Current literature reflects the need to balance the improved efficacy of early initiating prophylaxis with increased risk of perioperative bleeding. The purpose of this study was to compare the effectiveness and hemorrhage related safety of preoperative versus postoperative LMWH therapy for prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients...
February 12, 2016: BMC Musculoskeletal Disorders
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