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PE prevention in bleeding

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
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
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
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
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 Wa Lensing
BACKGROUND: Short-term anticoagulant treatment for acute deep-vein thrombosis (DVT) or pulmonary embolism (PE) effectively reduces the risk of recurrent disease during the first 6 to 12 months of therapy. Continued anticoagulation is often not instituted because of the perception among physicians that the risk of major bleeding will outweigh the risk of new venous thrombotic episodes. METHODS: Benefit-risk analysis using the randomized EINSTEIN-EXTENSION trial, which compared continued rivaroxaban versus placebo in 1197 patients with symptomatic DVT or PE who had completed 6-12 months of anticoagulation and in whom physicians had equipoise with respect to the need for continued anticoagulation...
June 1, 2016: Chest
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
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...
2016: Cochrane Database of Systematic Reviews
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...
2016: BMC Musculoskeletal Disorders
Nghi B Ha, Randolph E Regal
OBJECTIVE: To review current literature for anticoagulation in patients with cirrhosis and provide a summary of the effects of cirrhosis on the coagulation cascade, therapeutic monitoring through interpretation of antifactor Xa (anti-Xa), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) as well as current prophylaxis and treatment recommendations in cirrhotic patients. METHODS: A systematic electronic literature search was conducted in PubMed using the key termsanticoagulation, warfarin, low-molecular-weight heparin(LMWH),unfractionated heparin(UFH),target-specific oral anticoagulants, deep-vein thrombosis(DVT),pulmonary embolism(PE),portal vein thrombosis(PVT),venous thromboembolism, anti-Xa, activated partial thromboplastin time, anticoagulation therapeutic monitoring, coagulopathy, coagulation cascade, chronic liver disease, cirrhosis, anddecompensated liver disease STUDY SELECTION: Studies written in the English language from January 2000 to December 2015 were considered for this review article...
May 2016: Annals of Pharmacotherapy
Pedro Garcia, Wilson Ruiz, César Loza Munárriz
BACKGROUND: Venous thromboembolism (VTE) is a common condition in hospital patients. Considerable controversy is ongoing regarding optimal initial warfarin dosing for patients with acute deep venous thrombosis (DVT) and pulmonary embolism (PE). Achieving a therapeutic international normalized ratio (INR) with warfarin as soon as possible is important because this minimizes the duration of parenteral medication necessary to attain immediate anticoagulation, and it potentially decreases the cost and inconvenience of treatment...
2016: Cochrane Database of Systematic Reviews
Young Gon Na, Rui Fang, Yeon Ho Kim, Kwan Jae Cho, Tae Kyun Kim
We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding...
December 2015: Journal of Korean Medical Science
Dany Gaspard, Karen Vito, Christa Schorr, Krystal Hunter, David Gerber
Background. Thromboembolic events are major causes of morbidity, and prevention is important. We aimed to compare chemical prophylaxis (CP) and mechanical prophylaxis (MP) as methods of prevention in nonsurgical patients on mechanical ventilation. Methods. We performed a retrospective study of adult patients admitted to the Cooper University Hospital ICU between 2002 and 2010. Patients on one modality of prophylaxis throughout their stay were included. The CP group comprised 329 patients and the MP group 419 patients...
2015: Thrombosis
I David Kaye, Deepan N Patel, Eric J Strauss, Michael J Alaia, Garret Garofolo, Amaury Martinez, Laith M Jazrawi
INTRODUCTION: Historically, venous thromboembolism (VTE) in the setting of elective knee arthroscopy has been considered rare. However, more recently, the rate of deep vein thrombosis (DVT) has been reported to be approximately 10%. With increasing recognition of the potential for the development of thromboembolic events, several randomized trials have evaluated the efficacy of chemoprophylaxis in reducing the risk of VTE following knee arthroscopy. However, all of these studies have evaluated the efficacy of low molecular weight heparins (LMWH), with reductions in the risk of DVT ranging from 65% to 93%, but with the potential side effect of bleeding...
December 2015: Bulletin of the Hospital for Joint Diseases
Paul E Marik, Rodrigo Cavallazzi
BACKGROUND: Patients who have had an unprovoked deep venous thrombosis (DVT) or pulmonary embolus (PE) are at a high risk for recurrent venous thromboembolism (VTE). Extended "life-long" anticoagulation has been recommended in these patients. However, the risk benefit ratio of this approach is controversial and the role of the direct oral anticoagulants (DOACs) and aspirin is unclear. Furthermore, in some patients with a "weak provoking factor" there is clinical equipoise regarding continuation or cessation of anticoagulant therapy after treatment of the acute VTE event...
2015: PloS One
Matt Shirley, Sohita Dhillon
Edoxaban (Lixiana, Savaysa) is an oral, direct factor Xa inhibitor which has recently been approved for use in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) [collectively, venous thromboembolism (VTE)] and for the prevention of recurrent VTE. This article reviews the pharmacological properties of edoxaban as well as its tolerability and therapeutic efficacy in the treatment and prevention of recurrent VTE events. As demonstrated in the pivotal Hokusai-VTE phase III trial, once-daily edoxaban after initial treatment with heparin was non-inferior to standard therapy with heparin/warfarin in preventing recurrent VTE events and was associated with a significantly lower risk of clinically relevant bleeding than the traditional therapy...
November 2015: Drugs
Marc Blondon, Henri Bounameaux
No abstract text is available yet for this article.
November 17, 2015: Circulation
Anamaria Vera Jugrin, Volker Hösel, Anastasia Ustyugova, Maria De Francesco, Mark Lamotte, Tom Sunderland
BACKGROUND: Acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is traditionally managed with a short course of parenteral anticoagulation followed by 3-6 months of a vitamin-K antagonist. Non-vitamin K oral anticoagulants (NOACs) do not require routine monitoring and dose adjustment, thus potentially provide an alternative treatment option. METHODS AND RESULTS: Because of the lack of head-to-head clinical studies, an indirect comparison was conducted of dabigatran etexilate and rivaroxaban based on the respective phase III clinical trial...
2016: Journal of Medical Economics
Fabio S Taccone, Nicholas Bunker, Carl Waldmann, Daniel De Backer, Karim Brohi, Robert G Jones, Jean-Louis Vincent
BACKGROUND: Pulmonary embolism (PE) is a potentially life-threatening complication of critical illness. In trauma and neurosurgical patients with contraindications to anticoagulation, inferior vena cava (IVC) filters have been used to prevent PE, but their associated long-term complication rates and difficulties associated with filter removal have limited their use. The Angel catheter is a temporary device, which combined an IVC filter with a triple-lumen central venous catheter (IVC filter-catheter) and is intended for bedside placement and removal when no longer indicated...
September 2015: Journal of Trauma and Acute Care Surgery
Frank Noack, Bernd Schmidt, Mroawan Amoury, Dietrich Stoevesandt, Stephan Gielen, Birgit Pflaumbaum, Christiane Girschick, Heinz Völler, Axel Schlitt
BACKGROUND: Venous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension). Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center. METHODS: Data from consecutive pulmonary embolism (PE) patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated...
2015: Vascular Health and Risk Management
Francis Couturaud, Olivier Sanchez, Gilles Pernod, Patrick Mismetti, Patrick Jego, Elisabeth Duhamel, Karine Provost, Claire Bal dit Sollier, Emilie Presles, Philippe Castellant, Florence Parent, Pierre-Yves Salaun, Luc Bressollette, Michel Nonent, Philippe Lorillon, Philippe Girard, Karine Lacut, Marie Guégan, Jean-Luc Bosson, Silvy Laporte, Christophe Leroyer, Hervé Décousus, Guy Meyer, Dominique Mottier
IMPORTANCE: The optimal duration of anticoagulation after a first episode of unprovoked pulmonary embolism is uncertain. OBJECTIVES: To determine the benefits and harms of an additional 18-month treatment with warfarin vs placebo, after an initial 6-month nonrandomized treatment period on a vitamin K antagonist. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind trial (treatment period, 18 months; median follow-up, 24 months); 371 adult patients who had experienced a first episode of symptomatic unprovoked pulmonary embolism (ie, with no major risk factor for thrombosis) and had been treated initially for 6 uninterrupted months with a vitamin K antagonist were randomized and followed up between July 2007 and September 2014 in 14 French centers...
July 7, 2015: JAMA: the Journal of the American Medical Association
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