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PubMed2006

Pharmacological prevention of thromboembolism in patients with left ventricular dysfunction.

Chronic left ventricular systolic dysfunction is a well recognized problem with an increasingly significant impact on healthcare in the form of congestive heart failure (CHF). Advances in medicine have led to improved survival after myocardial infarction (MI) and as a result, an increased prevalence of left ventricular systolic dysfunction. An increased incidence of thromboembolism, especially stroke, in patients with left ventricular systolic dysfunction is also well recognized. Pharmacological strategies to prevent stroke have been proposed in numerous studies. For example, anticoagulation in patients with atrial fibrillation and heart failure has been shown to reduce mortality rates and the incidence of stroke; however, its role in patients with left ventricular dysfunction and normal sinus rhythm is unclear and utilization of anticoagulation in these patients varies widely. The role of aspirin to prevent thromboembolism in patients with CHF is controversial. The relatively new pharmacological agent ximelagatran, which has an advantage of unmonitored oral administration has the potential to change the anticoagulation strategy in patients with heart failure. Important trials to define optimal therapy for reducing the risk of thromboembolism and death in patients with left ventricular systolic dysfunction and sinus rhythm include the recently reported WATCH (Warfarin and Antiplatelet Therapy in Chronic Heart failure) trial and the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial, which is currently underway. The WATCH trial failed to outline significant differences between aspirin (acetylsalicylic acid), warfarin, and clopidogrel in the primary composite endpoint of all-cause mortality, nonfatal MI, and nonfatal stroke. Combined data from WATCH and WARCEF may provide sufficient statistical power to clarify outcomes such as stroke and death in patients with reduced cardiac ejection fraction. The pooled data may also help define optimal preventative measures for thromboembolism in patients with left ventricular systolic dysfunction and sinus rhythm.

Anticoagulants↗
PubMed1997

Venous thromboembolism and cancer: a two-way clinical association.

In recent years, a growing body of evidence has provided the convincing demonstration of a strong association between cancer and venous thromboembolism. This relationship is further supported by the risk of developing overt malignancy in patients with idiopathic venous thromboembolism. However, the cost-to-benefit ratio of an extensive diagnostic work-up aimed at identifying an occult cancer in patients with spontaneous thromboembolism still has to be demonstrated. During prolonged immobilization from any cause, and following surgical interventions, patients with cancer are at a remarkably higher risk of venous thromboembolism than patients free from malignant disorders. Standard heparin in adjusted doses or a low-molecular-weight heparin in doses commonly recommended for high risk surgical patients represent the prophylactic treatment of choice for cancer patients undergoing an extensive abdominal or pelvic intervention. Furthermore, the risk of thrombotic episodes is increased in cancer patients by chemotherapy and by the use of indwelling central venous catheters. Recent data suggest a positive benefit-to-risk ratio with the systematical use of fixed mini-dose of warfarin in both conditions. After experiencing an episode of thrombosis, cancer patients remain at risk of recurrence for as long as the cancer is active. Therefore, they should be protected by a long-term course of oral anticoagulation. The risk of recurrent thrombotic events despite adequate anticoagulation is higher in patients with cancer than in those without cancer. The routine use of long-term subcutaneous heparin therapy rather than oral anticoagulants should be reserved for patients in whom warfarin has been ineffective. Can antithrombotic drugs improve survival in cancer patients? In cancer patients affected by deep-vein thrombosis, the treatment with low-molecular-weight heparins has been reported to lower mortality at a higher extent than the standard heparin therapy. Such an observation suggests that these agents might develop an antineoplastic activity.

Humans↗
PubMed1979

Prophylaxis and therapy of venous thromboembolism.

Heparin is an anticoagulant drug which is used for the prophylaxis and treatment of venous thromboembolism and for the treatment of some cases of arterial thromboembolism. Venous thromboembolism is the commonest preventable cause of death in hospitalized patients, and the best approach to reduce its morbidity and mortality is the use of safe, effective, prophylaxis in patients at high risk. The use of low doses of heparin given s.c. (5000 units, 8 hourly)) has been shown in prospective clinical trials to be effective prophylaxis against venous thrombosis and nonfatal and fatal pulmonary embolism in patients undergoing general abdominothoracic surgery, without producing dangerous bleeding. Low-dose heparin, however, is not totally effective in patients undergoing hip surgery and suprapubic prostatectomy. The lack of benefit in these patients may be related to the intensity of the provocation to thrombosis. The use of heparin in large doses to treat thrombosis is associated with hemorrhagic complications in up to 30% of patients. There is evidence that continuous i.v. heparin is associated with fewer hemorrhagic complications than intermittent i.v. heparin, but the frequency is not related to the dose or to the use of laboratory monitoring. Hemorrhagic complications occur more frequently in elderly patients and in females and is more common following surgical operations. The frequency of recurrent venous thromboembolism is low in patients on therapeutic doses of heparin, and there is no difference in the frequency of recurrence in patients receiving heparin by continuous i.v. or intermittent i.v. administration.

Blood Platelet Disorders↗
PubMed1995

Comparing subcutaneous danaparoid with intravenous unfractionated heparin for the treatment of venous thromboembolism. A randomized controlled trial.

OBJECTIVE: To compare the efficacy and safety of two subcutaneous doses of danaparoid with that of continuous intravenous administration of unfractionated heparin in the treatment of venous thromboembolism. DESIGN: An open-label, randomized, multicenter clinical trial. SETTING: One university hospital and two university-affiliated hospitals. PATIENTS: 209 patients suspected to have venous thromboembolism. Of these, 188 had a confirmed diagnosis (by ventilation-perfusion lung scan and ultrasonography or contrast venography of the leg) and received study medication. INTERVENTIONS: Patients were randomly assigned to either low-dose danaparoid (intravenous loading dose of 1250 U followed by 1250 U administered subcutaneously twice daily [n = 65]); high-dose danaparoid (intravenous loading dose of 2000 U followed by 2000 U administered subcutaneously twice daily [n = 63]); or unfractionated heparin (intravenous loading dose of 2500 U followed by dose-adjusted continuous infusion [n = 60]). Treatment lasted at least 5 days and was continued until anticoagulation (achieved with acenocoumarol) was adequate. MEASUREMENTS: Efficacy determined clinically and by repeated imaging tests on treatment days 5 to 8; safety determined by daily assessment for bleeding. RESULTS: Two lung scans were done in each of 179 patients; ultrasonography or venography of the leg was done twice in each of 173 patients; and both repeated leg and lung tests were done in 166 patients. A significant reduction in recurrence or extension of venous thromboembolism was seen in patients receiving high-dose danaparoid (8 of 63 [13%]) compared with patients receiving intravenous unfractionated heparin (17 of 60 [28%]; relative risk, 0.45 [95% CI, 0.21 to 0.96]). Four of 61 patients receiving high-dose danaparoid (7%) and 14 of 58 patients receiving unfractionated heparin (24%) had recurrence of pulmonary embolism (relative risk, 0.27 [CI, 0.09 to 0.78]); 3 of 58 patients receiving high-dose danaparoid (5%) and 6 of 54 patients receiving unfractionated heparin (11%) had recurrence of deep venous thrombosis (relative risk, 0.47 [CI, 0.12 to 1.77]). Occurrence of major and minor bleeding was similar in the three groups; major bleeding occurred in 1 patient receiving low-dose danaparoid, 1 patient receiving high-dose danaparoid, and 2 patients receiving heparin. CONCLUSIONS: Our results suggest that high-dose danaparoid is safer and more effective than unfractionated heparin for the treatment of venous thromboembolism.

Adult↗
PubMed2000

Ardeparin sodium for extended out-of-hospital prophylaxis against venous thromboembolism after total hip or knee replacement. A randomized, double-blind, placebo-controlled trial.

BACKGROUND: The optimal duration of prophylaxis against venous thromboembolism after total hip or knee replacement is uncertain. OBJECTIVE: To determine the efficacy and safety of extended out-of-hospital prophylaxis with low-molecular-weight heparin (ardeparin sodium). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 33 community, university, or university-affiliated hospitals. PATIENTS: 1195 adults who had elective total hip or knee replacement and completed 4 to 10 days of postoperative ardeparin prophylaxis. INTERVENTION: Daily subcutaneous ardeparin (100 anti-Xa IU/kg of body weight) or placebo from time of hospital discharge to 6 weeks after surgery. MEASUREMENTS: Symptomatic, objectively documented venous thromboembolism or death, along with major bleeding, from time of hospital discharge to 12 weeks after surgery. RESULTS: Patients who received ardeparin (n = 607) and those who received placebo (n = 588) did not differ significantly in the cumulative incidence of venous thromboembolism or death (9 cases [1.5%] compared with 12 cases [2.0%]; odds ratio, 0.7 [95% CI, 0.3 to 1.7]; P > 0.2; absolute difference, -0.56 percentage points [CI, -2.2 to 1.1 percentage points]) or major bleeding (2 cases [0.3%] compared with 3 cases [0.5%]). CONCLUSIONS: Among patients who had total knee or total hip replacement and received 4 to 10 days of postoperative ardeparin prophylaxis, the cumulative incidence of symptomatic venous thromboembolism or death after hospital discharge was not significantly reduced by extended out-of-hospital ardeparin prophylaxis. Extended ardeparin use could provide a maximum 2.2-percentage point true reduction in such events. The benefit of extended ardeparin use is not clinically important for most patients. Future research should identify high-risk patients who would benefit most from extended prophylaxis.

Adult↗
PubMed2003

Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis.

BACKGROUND: Clinicians should consider the clinical impact of anticoagulant-related bleeding when deciding on the duration of anticoagulant therapy in patients with venous thromboembolism. PURPOSE: To provide reliable estimates of the clinical impact of anticoagulant-related bleeding, defined as the case-fatality rate of major bleeding and the risk for intracranial bleeding. DATA SOURCES: MEDLINE (January 1989 to May 2003), Cochrane Controlled Trial Registry, thromboembolism experts, and reference lists; English-language literature only. STUDY SELECTION: Randomized, controlled trials and prospective cohort studies that investigated patients with venous thromboembolism who received oral anticoagulant therapy (target international normalized ratio, 2.0 to 3.0) for at least 3 months and that reported major bleeding and death as primary study outcomes. DATA EXTRACTION: Two reviewers independently extracted data on the number of anticoagulant-related major and intracranial bleeding episodes and on whether these events were fatal or nonfatal. DATA SYNTHESIS: The authors analyzed 33 studies involving 4374 patient-years of oral anticoagulant therapy. For all patients, the case-fatality rate of major bleeding was 13.4% (95% CI, 9.4% to 17.4%) and the rate of intracranial bleeding was 1.15 per 100 patient-years (CI, 1.14 to 1.16 per 100 patient-years). For patients who received anticoagulant therapy for more than 3 months, the case-fatality rate of major bleeding was 9.1% (CI, 2.5% to 21.7%), and the rate of intracranial bleeding was 0.65 per 100 patient-years (CI, 0.63 to 0.68 per 100 patient-years) after the initial 3 months of anticoagulation. CONCLUSION: The clinical impact of anticoagulant-related major bleeding in patients with venous thromboembolism is considerable, and clinicians should take this into account when deciding whether to continue long-term oral anticoagulant therapy in an individual patient.

Administration, Oral↗
PubMedDate not supplied

The prevention of venous thromboembolism: a statewide evaluation of practices in Massachusetts.

The objective of this study was to determine the proportion of Massachusetts Medicare patients who received prophylaxis for venous thromboembolism following colectomy, hysterectomy or total hip arthroplasty. The sample frame was all 90 Massachusetts acute care hospitals, and the time frame was 1 April to 30 September 1994. The patients discharged with an International Classification of Disease (ICD-9-CM) discharge diagnostic code (recorded in the Massachusetts Medicare Claims Database) for colectomy, hysterectomy or total hip arthroplasty were used to identify the target patient population. The sample population comprised 1397 patients randomly selected from the target population, including 467 total hip arthroplasties, 474 colectomies, and 456 hysterectomies. Medical records were reviewed by trained nurse abstractors who collected information on the use of prophylaxis for venous thromboembolism. Prophylaxis for venous thromboembolism was employed by surgeons practicing in Massachusetts hospitals in 93 per cent of total hip arthroplasty cases (regional variation 85-98 per cent), 84 per cent of colectomies (regional variation 57-93 per cent), 66 per cent of hysterectomies (regional variation 35-71 per cent), and in 87 per cent of the subset of 111 hysterectomies with malignancy (regional variation 25-100 per cent). The results of this statewide study demonstrated significant regional and hospital-to-hospital variation in use of prophylaxis for venous thromboembolism following major surgery. A lower rate of prophylaxis use was observed in hospitals with fewer than 200 beds and in hospitals that did not have teaching programmes. Hospitals with below-average rates of prophylaxis were targeted for intensive quality improvement interventions.

Anticoagulants↗
PubMed1998

Heparin and low-molecular-weight heparin therapy for venous thromboembolism. The twilight of anticoagulant monitoring.

Recent improvements in the methods of clinical trials and the use of accurate objective tests to detect venous thromboembolism have made possible a series of randomized trials to evaluate various treatments for venous thromboembolism. The results of these trials have resolved many of the uncertainties a clinician confronts in selecting an appropriate course of anticoagulant therapy. These trials have shown that the intensity of both initial heparin treatment and long-term anticoagulant therapy must be sufficient to prevent unacceptable rates of recurrence of venous thromboembolism. Patients with proximal deep vein thrombosis who receive inadequate anticoagulant therapy have a risk of clinically evident, objectively documented recurrent venous thromboembolism that approaches 20% to 25%. The need for therapy with heparin and the importance of monitoring blood levels of the effect of heparin have been established. The importance of achieving adequate heparinization was suggested by a nonrandomized trial in 1972 and randomized trials in the 1980s have confirmed this finding. Furthermore, randomized trials have demonstrated the importance of achieving adequate heparinization early in the course of therapy. Unfractionated intravenous heparin has provided an effective therapy for more than half a century, but the need to monitor therapy and establish therapeutic levels is a fundamental problem. It is evident that validated heparin protocols are more successful in establishing adequate heparinization than intuitive ordering by the clinician. However, even with the best of care using a heparin protocol, some patients treated with intravenous heparin will receive subtherapy. In this context, subtherapy reflects a practical limitation of the use of unfractionated heparin, rather than a poor standard of care. Furthermore, it is recognized that the practical difficulties associated with heparin administration are compounded by the substantive practical difficulties of standardizing APTT testing and the therapeutic range. Our findings emphasize the confounding effect that initial heparin treatment has on long-term outcome. In future trials of longterm therapy, it is imperative that the initial therapy is of adequate intensity and duration; failure to administer adequate initial treatment may lead to a poor outcome that is falsely attributed to the long-term therapy under evaluation. Therapy with low-molecular-weight heparin, which does not require monitoring and dose finding, is the likely practical solution to these dilemmas. Based on the experience of difficulties achieving adequate therapy with subcutaneous unfractionated heparin dosing, we administered a low-molecular-weight heparin formulation in a single daily dose, rather than splitting the treatment into 2 equal doses. The initial intensity of therapy was thereby maximized. Therapy with low-molecular-weight heparin proved to be better than therapy with unfractionated heparin.

Animals↗
PubMedDate not supplied

Thromboembolism in inflammatory bowel disease.

Thromboembolism represents a severe complication of inflammatory bowel disease occurring in young patient, with active disease. Deep venous thrombosis and pulmonary embolism are the most frequent thromboembolism manifestations. Arterial complications and unusual sites for thromboembolism are more rare. Overall, inflammatory bowel disease is a real prothrombotic state as almost all parameters of coagulation are enhanced. Anticoagulation during the episode of thromboembolism is mandatory, and sometimes may ameliorate the course of inflammatory bowel disease.

Adult↗
PubMed1999

[Cancer and thromboembolism].

Thromboembolism is the most common complication in patients with malignant diseases. The recent studies have indicated that the pathogenesis of thromboembolism in cancer is associated with the hemostatic alternations induced by cancer cells and cancer-stimulated mononuclear cells: injury to the endothelial lining of blood vessels, activation of blood coagulation and depression of anticoagulant function. Although thromboembolism is generally observed in patients with advanced cancer, it may occur in patients with occult cancer. In the treatment of thromboembolism, the administration of low molecular heparin has been introduced recently, in addition to the immediate and intensive treatment of cancer.

Humans↗
PubMed1999

Low molecular weight heparins in the prevention of venous thromboembolism in nonsurgical patients.

Hospitalized nonsurgical patients are at risk of developing venous thromboembolic disease (VTED) but, in contrast to surgical patients, only a limited number of prevention trials have been performed. Guidelines for optimal prophylaxis, particularly with respect to low molecular weight heparins (LMWHs), are not definitive. The Fifth American College of Chest Physicians' (ACCP) Consensus on Antithrombotic Therapy makes limited recommendations on the use of LMWH in patients. Recommendations are made for ischemic stroke and general medical patients, but there are insufficient clinical trial data to produce firm recommendations on the use of LMWHs in acute myocardial infarction, pregnancy, and cancer patients. Patients with acute ischemic stroke are at high risk for VTED. The ACCP Consensus recommends employing either low-dose UFH or LMWH. A recent comparison between enoxaparin and UFH revealed an incidence of thromboembolic events in 20% of patients randomized to enoxaparin, compared with 35% in the UFH-treated group. Although the ACCP Consensus states that both low-dose unfractionated heparin (UFH) and LMWH provide effective prophylaxis in general medical patients, particularly those with congestive heart failure and/or pulmonary infections, no specific LMWH or dose is specified. The recently completed Thromboembolism Prevention in Cardiopulmonary Diseases with Enoxaparin (PRINCE) trial compared once-daily enoxaparin with three times daily UFH. Enoxaparin was at least as effective as UFH in reducing the risk of thromboembolic events by 19%. In high-risk pre-defined subgroups with heart failure, enoxaparin was significantly more effective. It is not possible to recommend a specific LMWH for prophylaxis in medical patients, but the recent position adopted by the United States Food and Drug Administration and the World Health Organization that LMWHs are noninterchangeable drugs suggests that thromboprophylaxis guidelines should be strengthened to reflect the level of evidence for each individual LMWH.

Breast Neoplasms↗
PubMed2000

[Venous thromboembolism in pregnancy].

A DUAL CHALLENGE: Pregnancy is a physiological state favoring the development of venous thromboembolism and sometimes discloses a coagulation disorder. Due to the presence of the fetus, suspected venous thromboembolism in a pregnant woman raises a dual challenge for the clinician: confirmation of the clinically suspected diagnosis using imaging techniques exposing the fetus to as little radiation as possible, and adapted anticoagulant therapy taking into account the teratogenic risk. MILD TO MODERATE DISEASE: Excepting exceptionally severe cases, the only validated long-term treatment is continuous infusion heparin. However, because of the difficulties inherent in the use and control of this type of administration, most clinicians prefer low-molecular-weight heparins (LMWH) although these pharmaceutical products have not acquired official approval for this indication. PREVENTION: The optimal therapeutic approach for prevention of venous thromboembolism in a pregnant woman with an acquired or hereditary coagulation disorder or a history of venous thromboembolism remains to be defined. New clinical trials are needed to validate the use of LMWH in this indication and determine the therapeutic approach in certain risk situations and at delivery.

Adult↗
PubMed2000

[Necessity of permanent anticoagulant therapy for isolated mitral valve replacement with bioprosthetic heart valve to prevent the postoperative thromboembolic complications].

One hundred fifty four patients underwent isolated mitral valve replacement with bioprosthetic heart valve at Hyogo Medical College Hospital from November 1973 to December 1998. A porcine bioprosthetic valve was replaced in 82 patients (Hancock 43, Carpentier-Edwards 26, Hancock II 13) and pericardial bioprosthetic valve in 72 patients (Ionescue-Shiley 39, Carpentier-Edwards 33) with a mean follow-up of 1,410 patients-years. Their thromboembolism rates were also analyzed in linear and actuarial term over the 15-year period. The incidence of thromboembolism rate was 2.5%/pt.yr. Thromboembolic free rates for patients with anticoagulant therapy were significantly decreased for patients without therapy. Thromboembolic free rates for patients with atrial fibliration were also were significantly decreased for patients with sinus rhythm because the patients with sinus rhythm were not on anticoagulant therapy. In conclusion, it is necessary for the all patients to be on anticoagulant therapy after mitral valve replacement with bioprosthetic valves, even though patients with sinus rhythm.

Adult↗
PubMed2000

Criteria for evaluating evidence that laboratory abnormalities are associated with the development of venous thromboembolism.

The identification of conditions associated with an increased risk of venous thromboembolism may indicate the need for aggressive prophylaxis during periods of high risk, prolonged anticoagulant therapy after an initial venous thromboembolic episode, the investigation of asymptomatic family members and the avoidance of oral contraceptives. Advances in laboratory medicine have led to the identification and assessment of many proteins responsible for normal hemostasis, and associations between abnormalities in a number of these proteins and venous thromboembolism have been reported. Without the ability to appraise this information critically, physicians may be unable to determine whether or how they should modify their clinical practice. Criteria for determining whether specific laboratory abnormalities have a relationship with venous thromboembolism are proposed here, and one example of the application of these guidelines is provided.

Anticoagulants↗
PubMed2000

The incidence of thrombovenous and thromboembolic complications in kidney transplant patients with recurrent glomerulonephritis is dependent on the occurrence of severe proteinuria.

BACKGROUND: Patients with recurrent glomerulonephritis (RG) after kidney transplantation are at high risk for thromboembolic events but it is unclear when the risk begins to increase. PATIENTS AND METHODS: We evaluated the risk for thrombovenous and thromboembolic complications in relation to the occurrence of severe proteinuria (> or = 2 g protein in 24-hour urine) in 15 renal allograft recipients with biopsy-proven RG, who had received 20 allografts RG. The total period of observation was 53 (10-91) months. The post-transplant period before the occurrence of severe proteinuria lasted 18 (1-34) months and the subsequent proteinuric period until the end of the study, 35 (9-85) months. RESULTS: The monthly incidence of thrombovenous and thromboembolic complications was only 1/18 in the first period before and in contrast, 11/35 in the subsequent period after the occurrence of severe proteinuria. The mean urinary protein excretion increased from 0.4 +/- 0.1 g/day immediately after transplantation to 6.1 +/- 4.8 g/day at the end of the study (p < 0.001). During the same period there was a 1.2-fold increase of fibrinogen (from 366 +/- 88 to 442 +/- 120 mg/dl, p < 0.025) and a 1.2-fold decrease of antithrombin III (from 110 +/- 12 to 92 +/- 12%, p < 0.001). All thrombotic complications occurred in 6 patients with 9 grafts; at the end of the study this group showed higher fibrinogen concentrations (454 +/- 155 versus 433 +/- 89 mg/dl, NS) m and lower antithrombin III levels (88 +/- 11 versus 97 +/- 11%, p < 0.05) than the group without thrombotic complications. CONCLUSION: In kidney transplant patients with RG a high risk for thrombovenous and thromboembolic complications can be obs- served after the occurrence of severe proteinuria; this can mainly be explained by high fibrinogen and low antithrombin III levels. Anticoagulation therapy should be started in patients with RG immediately after the occurrence of severe proteinuria.

Adult↗
PubMed2000

Abrupt versus gradual withdrawal of vitamin K antagonist treatment in patients with venous thromboembolic disease: assessment of hypercoagulability and clinical outcome.

BACKGROUND: It is yet unclear whether vitamin K antagonist treatment should be stopped abruptly or gradually after an episode of venous thromboembolism. The mode of withdrawal might influence a potential development of a hypercoagulable state, which could influence the risk for recurrent disease. METHODS: We prospectively studied 37 consecutive patients in whom acenocoumarol was discontinued either abrupt (18) or gradually (19) (2/3 and 1/3 of the initial dose for one week). Blood sampling was performed at various time points up to 18 days after complete withdrawal and was analysed for INR, prothrombin fragment F1 + 2 and D-dimer. All patients were clinically followed-up for the assessment of the association between hypercoagulability and occurrence of disease such as recurrent venous thromboembolism or malignancy. RESULTS: An approximately fourfold increase was observed (median increase from 0.3 to 1.3 nmol/l) in the F1 + 2 levels after both abrupt and gradual withdrawal and in the D-dimer concentrations in the abrupt withdrawal group (0.10 to 0.44 mg/l), while those in whom acenocoumarol was discontinued gradually showed a less pronounced increase of the D-dimer levels (0.11 to 0.29 mg/L) (not significant). During follow-up one recurrent venous thromboembolic event occurred in each group, and a diagnosis of cancer was made four times. All these patients had the highest D-dimer concentrations measured in the entire study group. CONCLUSIONS: This study indicates the potential for a hypercoagulable state after acenocoumarol discontinuation, which was not prevented by tapering the acenocoumarol dose. D-dimer, measured 2 to 3 weeks after acenocoumarol withdrawal, might be an important tool to identify patients at risk for recurrent venous thromboembolism and/or for the presence of an underlying malignancy.

Acenocoumarol↗
PubMed2001

Low molecular weight heparin administered once versus twice daily in patients with venous thromboembolism: a meta-analysis.

BACKGROUND: Low molecular weight heparin is as effective and safe as unfractionated heparin for treatment of acute venous thromboembolism. It is uncertain whether low molecular weight heparin should be administered once-daily or twice-daily in this setting. METHOD: A meta-analysis of randomized studies which directly compared once- and twice-daily administration of low molecular weight heparin for the treatment of acute venous thromboembolism was performed. A literature search was performed using Advanced Pub Med and the Cochrane library database, and abstracts from recent meetings were reviewed. Two investigators extracted data independently. RESULTS: Five studies, involving 1522 patients, were eligible. There were no statistically significant differences in the frequencies of symptomatic (odds ratio, 0.85 in favor of once-daily therapy at three months, p = 0.6), and asymptomatic, recurrent venous thromboembolism, total and major bleeds (odds ratio, 1.16 in favor of twice-daily therapy at 10 days, p = 0.8); and death, at 10 days, as well as at three months of follow-up. CONCLUSION: Once-daily low molecular weight heparin appears to be as effective and safe as twice-daily administration for the acute treatment of venous thromboembolism. However, there is inadequate data from studies that directly compared once-daily and twice-daily administration to be able to exclude the possibility of a higher frequency of fatal bleeding with once-daily therapy.

Acute Disease↗
PubMed2001

[Thrombophilia and thromboembolic disease. A case report].

Congenital thrombophilia, specifically thrombophilia due to Leiden modified factor V as the cause of thromboembolic disease, is discussed. Thromboembolic disease is potentially fatal and disabling. A clinical case is presented of a girl of 15 with Leiden factor V thrombophilia in which all the typical thromboembolic events occurred: superficial thrombophlebitis, rapidly developing deep venous thrombosis of an extremity and ischaemic arterial thrombosis of the distal arterial trunk of the same extremity. Systemic thrombolytic therapy done quickly cleared up the acute phase of the thromboembolic event without it being necessary to resort to thrombectomy and prevented post-thrombotic sequelae involving the extremity.

Adolescent↗