Embolism and thrombosis: Difference between revisions
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imported>Robert Badgett (Started 'Cause/etiology') |
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| Levine, 1995<ref name="pmid8584992">{{cite journal |author=Levine MN, Hirsh J, Gent M, ''et al'' |title=Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis |journal=Thromb. Haemost. |volume=74 |issue=2 |pages=606–11 |year=1995 |month=August |pmid=8584992 |doi= |url= |issn=}}</ref> || Acute DVT with normal normal impedance plethysmogram (IPG) after 4 weeks || 1 mo || 3 mos || Prolonged tended to do better | | Levine, 1995<ref name="pmid8584992">{{cite journal |author=Levine MN, Hirsh J, Gent M, ''et al'' |title=Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis |journal=Thromb. Haemost. |volume=74 |issue=2 |pages=606–11 |year=1995 |month=August |pmid=8584992 |doi= |url= |issn=}}</ref> || Acute DVT with normal normal impedance plethysmogram (IPG) after 4 weeks || 1 mo || 3 mos || Prolonged tended to do better | ||
|} | |} | ||
[[Clinical practice guideline]]s by the [[American College of Chest Physicians]] address the duration of anticoagulation for [[deep venous thrombosis]] and [[pulmonary embolism]].<ref name="pmid18574272">{{cite journal |author=Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ |title=Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=Chest |volume=133 |issue=6 Suppl |pages=454S–545S |year=2008 |month=June |pmid=18574272 |doi=10.1378/chest.08-0658 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574272 |issn=}}</ref> Although initial trials suggested lack of benefit from prolonged anticoaguation<ref name="pmid16091573">{{cite journal |author=Ost D, Tepper J, Mihara H, Lander O, Heinzer R, Fein A |title=Duration of anticoagulation following venous thromboembolism: a meta-analysis |journal=JAMA |volume=294 |issue=6 |pages=706–15 |year=2005 |month=August |pmid=16091573 |doi=10.1001/jama.294.6.706 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16091573 |issn=}}</ref>, trials since 1995 favor longer anticoagulation. In patients who have had ''recurrent DVTs'' (two or more), anticoagulation is generally "life-long." The [[Cochrane Collaboration]] and others have meta-analyzed the risk and benefits of prolonged anti-coagulation.<ref name="pmid16437432">{{cite journal |author=Hutten BA, Prins MH |title=Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD001367 |year=2006 |pmid=16437432 |doi=10.1002/14651858.CD001367.pub2}}</ref><ref name="pmid16091573"/ | [[Clinical practice guideline]]s by the [[American College of Chest Physicians]] address the duration of anticoagulation for [[deep venous thrombosis]] and [[pulmonary embolism]].<ref name="pmid18574272">{{cite journal |author=Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ |title=Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=Chest |volume=133 |issue=6 Suppl |pages=454S–545S |year=2008 |month=June |pmid=18574272 |doi=10.1378/chest.08-0658 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574272 |issn=}}</ref> Although initial trials suggested lack of benefit from prolonged anticoaguation<ref name="pmid16091573">{{cite journal |author=Ost D, Tepper J, Mihara H, Lander O, Heinzer R, Fein A |title=Duration of anticoagulation following venous thromboembolism: a meta-analysis |journal=JAMA |volume=294 |issue=6 |pages=706–15 |year=2005 |month=August |pmid=16091573 |doi=10.1001/jama.294.6.706 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16091573 |issn=}}</ref>, trials since 1995 favor longer anticoagulation. In patients who have had ''recurrent DVTs'' (two or more), anticoagulation is generally "life-long." The [[Cochrane Collaboration]] and others have meta-analyzed the risk and benefits of prolonged anti-coagulation.<ref name="pmid16437432">{{cite journal |author=Hutten BA, Prins MH |title=Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD001367 |year=2006 |pmid=16437432 |doi=10.1002/14651858.CD001367.pub2}}</ref><ref name="pmid16091573"/> | ||
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| LMWH for the first 3 to 6 months of long-term anticoagulant therapy | | LMWH for the first 3 to 6 months of long-term anticoagulant therapy | ||
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====Using D-dimer to determine duration of treatment==== | |||
[[Main|{{D-dimer}} | |||
==Prevention== | ==Prevention== | ||
Revision as of 12:44, 30 January 2009
Embolism and thrombosis is "a collective term for pathological conditions which are caused by the formation of a blood clot (thrombus) in a blood vessel, or by blocking of a blood vessel with an embolus, undissolved materials in the blood stream."[1]
The United States Surgeon General has announced a call to action to prevent Deep Vein Thrombosis and Pulmonary Embolism.[2]
Classification
- Embolism, includes pulmonary embolism
- Thromboembolism
- Thrombosis, includes deep venous thrombosis
Cause/etiology
One risk factor is hypercoagulability due to cancer. Cancer can be found in up to 10% of patients within one year of embolism or thrombosis.[3]
Treatment
Embolism and thrombosis may be prevented by anticoagulation with anticoagulants.
Duration of treatment
| Patients | Duration of short course |
Duration of long course |
findings | |
|---|---|---|---|---|
| Campbell, 2007[4] | DVT or PE without prior episode within 3 years | 3 mos | 6 mos | Prolonged tended to do slightly better |
| Schulman, 2003[5] | DVT or PE. 13% had prior VTE. | 6 mos | 24 mos | Prolonged did better |
| Kearon, 2004[6] | First episode of VTE due to transient risk factor | 1 mo | 3 mos | Prolonged did better |
| Ridker, 2003[7] | Idiopathic VTE. 30% had prior VTE | 6 mos | 2.1 yrs | Prolonged did better |
| Agnelli, 2001[8] | First episode of idiopathic DVT | 3 mos | 1 yr | Prolonged did better while anticoagulated, but after two years there was no difference |
| Kearon, 1999[9] | First episode of idiopathic VTE. | 3 mos | 2 yrs | Prolonged did better |
| Pinede, 2001[10] | DVT or PE without prior episode within 3 years | 6 wks for distal DVT; 3 mos for proximal or PE |
12 wks for distal DVT; 6 mos for proximal or PE |
Prolonged tended to do slightly better |
| Levine, 1995[11] | Acute DVT with normal normal impedance plethysmogram (IPG) after 4 weeks | 1 mo | 3 mos | Prolonged tended to do better |
Clinical practice guidelines by the American College of Chest Physicians address the duration of anticoagulation for deep venous thrombosis and pulmonary embolism.[12] Although initial trials suggested lack of benefit from prolonged anticoaguation[13], trials since 1995 favor longer anticoagulation. In patients who have had recurrent DVTs (two or more), anticoagulation is generally "life-long." The Cochrane Collaboration and others have meta-analyzed the risk and benefits of prolonged anti-coagulation.[14][13]
| Setting | Recommended duration |
|---|---|
| Single DVT due to transient risk factor | 3 months |
| Single unprovoked DVT | at least 3 months (longer if favorable risks for anticoagulation) |
| Second episode of unprovoked VTE | long-term treatment |
| DVT in patients with cancer | LMWH for the first 3 to 6 months of long-term anticoagulant therapy |
Using D-dimer to determine duration of treatment
[[Main|Template:D-dimer
Prevention
Among patients with cancer, anticoagulation does not help in the primary prevention of embolism and thrombosis.[15]
References
- ↑ Anonymous (2024), Embolism and thrombosis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Office of Public Health and Science (2008).
- ↑ Carrier M, Le Gal G, Wells PS, Fergusson D, Ramsay T, Rodger MA (September 2008). "Systematic review: the Trousseau syndrome revisited: should we screen extensively for cancer in patients with venous thromboembolism?". Annals of internal medicine 149 (5): 323–33. PMID 18765702. [e]
- ↑ Campbell IA, Bentley DP, Prescott RJ, Routledge PA, Shetty HG, Williamson IJ (March 2007). "Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial". BMJ 334 (7595): 674. DOI:10.1136/bmj.39098.583356.55. PMID 17289685. PMC 1839169. Research Blogging.
- ↑ Schulman S, Wåhlander K, Lundström T, Clason SB, Eriksson H (October 2003). "Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximelagatran". N. Engl. J. Med. 349 (18): 1713–21. DOI:10.1056/NEJMoa030104. PMID 14585939. Research Blogging.
- ↑ Kearon C, Ginsberg JS, Anderson DR, et al (May 2004). "Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor". J. Thromb. Haemost. 2 (5): 743–9. DOI:10.1046/j.1538-7836.2004.00698.x. PMID 15099280. Research Blogging.
- ↑ Ridker PM, Goldhaber SZ, Danielson E, et al (April 2003). "Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism". N. Engl. J. Med. 348 (15): 1425–34. DOI:10.1056/NEJMoa035029. PMID 12601075. Research Blogging.
- ↑ Agnelli G, Prandoni P, Santamaria MG, et al (July 2001). "Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators". N. Engl. J. Med. 345 (3): 165–9. PMID 11463010. [e]
- ↑ Kearon C, Gent M, Hirsh J, et al (March 1999). "A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism". N. Engl. J. Med. 340 (12): 901–7. PMID 10089183. [e]
- ↑ Pinede L, Ninet J, Duhaut P, et al (May 2001). "Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis". Circulation 103 (20): 2453–60. PMID 11369685. [e]
- ↑ Levine MN, Hirsh J, Gent M, et al (August 1995). "Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis". Thromb. Haemost. 74 (2): 606–11. PMID 8584992. [e]
- ↑ 12.0 12.1 Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ (June 2008). "Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest 133 (6 Suppl): 454S–545S. DOI:10.1378/chest.08-0658. PMID 18574272. Research Blogging.
- ↑ 13.0 13.1 Ost D, Tepper J, Mihara H, Lander O, Heinzer R, Fein A (August 2005). "Duration of anticoagulation following venous thromboembolism: a meta-analysis". JAMA 294 (6): 706–15. DOI:10.1001/jama.294.6.706. PMID 16091573. Research Blogging.
- ↑ Hutten BA, Prins MH (2006). "Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism". Cochrane database of systematic reviews (Online) (1): CD001367. DOI:10.1002/14651858.CD001367.pub2. PMID 16437432. Research Blogging.
- ↑ Wells PS (May 2008). "Review: evidence for the effectiveness of anticoagulation therapy or prophylaxis for VTE in cancer is limited". ACP J. Club 148 (3): 7. PMID 18489070. [e]