Track topics on Twitter Track topics that are important to you
Many pharmacologic options are available for prevention and treatment of venous thromboembolism (VTE). The anticoagulant selected may vary according the individual patient situation such as the acute versus chronic setting, renal function and indication for either VTE prevention or treatment. Established methods of pharmacologic prophylaxis agents include heparinoids, injectable anti-Xa inhibition and vitamin K antagonists (VKA). The novel anticoagulants have recently been incorporated into orthopedic surgery prophylaxis pathways and can be used for VTE treatment. Chronic VTE management, however, has largely been managed with the use VKA. The advantages of VKA include low cost, familiarity with use, and established protocols to manage catastrophic bleeding. VKA use, however, poses hurdles including the fact that correct dosing can be empiric, the existence of multiple potential medication and dietary interactions, and the possiblity for complications when anticoagulation levels are not well monitored. In contrast, the novel anticoagulants offer ease of dosing, reliable pharmacokinetics and low risk of interactions with other medications or diet. Potential hazards of the novel anticoagulants include high costs, questionable therapeutic benefit in those with poor adherence, a reliance on renal clearance, lack of reliable reversibility in the event of catastrophic bleeding, as well as incomplete familiarity with use by the general practitioner. Although clinical trials demonstrate promise of greater applicability of use of these novel agents, hospital systems will need to simultaneously create a plan for appropriate management of the use of these agents, an anticoagulation stewardship program. As guidelines are adopted to prevent and manage VTE, an appreciation for this new level of complexity is essential.
Jefferson Vascular Center, Jefferson Medical College, Thomas Jefferson University Hospitals, 111 S. 11th Street, Suite 6270, Philadelphia, PA, 19107, USA, firstname.lastname@example.org.
This article was published in the following journal.
Name: Current treatment options in cardiovascular medicine
After diagnosis of cancer-associated venous thromboembolism (VTE), guidelines recommend to consider continuing anticoagulant treatment until patients are cured from cancer, although the safety of stop...
While the association between smoking and arterial cardiovascular events has been well established, the association between smoking and venous thromboembolism (VTE) remains controversial.
Cancer patients have a 2-7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review ...
Venous thromboembolism occurs frequently in cancer patients. Two variants in the Factor 5 (F5) gene (rs6025 encodes the Leiden mutation (FVL) R506Q, and rs4524 encodes K858R) have been found to be ass...
Venous thromboembolism chemoprophylaxis remains underutilized in hospitalized medical patients at high risk for venous thromboembolism. We assessed the effect of a healthcare quality improvement initi...
The main objective of the study is to develop or validate a clinical prediction rule for major bleeding in patients on oral anticoagulant therapy who have been safely anticoagulated witho...
The aim of this study estimate VTE incidence. Investigators prospectively record all cases of symptomatic pulmonary embolism (PE) and deep vein thrombosis (DVT) of the lower limbs diagnose...
The purpose of this study is to determine if the risk of recurrent venous thromboembolism (VTE) after stopping therapy is low and acceptable in patients with a first unprovoked proximal de...
Optimal duration of oral anticoagulant therapy in patients with recurrent episodes of venous thromboembolism (VTE) is a matter of debate and recommendations are based on inadequate evidenc...
The study objective is to evaluate the efficacy and safety of oral YM150 for 52 weeks in patients with a history of venous thromboembolism.
Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Obstruction of a vein or VEINS (embolism) by a blood clot (THROMBUS) in the blood stream.
Instruments that generate intermittent forces, uniformed or graduated, to facilitate the emptying of VEINS. These devices are used to reduce limb EDEMA and prevent venous THROMBOEMBOLISM, such as deep vein thrombosis in the legs.
An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide.
Rare vascular anomaly involving a communication between the intracranial and extracranial venous circulation via diploe, the central spongy layer of cranial bone. It is often characterized by dilated venous structures on the scalp due to abnormal drainage from the intracranial venous sinuses. Sinus pericranii can be congenital or traumatic in origin.
Nephrology - kidney function
Nephrology is a specialty of medicine and pediatrics that concerns itself with the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation). Systemic conditions...
Within medicine, nutrition (the study of food and the effect of its components on the body) has many different roles. Appropriate nutrition can help prevent certain diseases, or treat others. In critically ill patients, artificial feeding by tubes need t...