ITEMS IN AFP WITH KEYWORD:
Deep Venous Thrombosis
Anticoagulation is the mainstay of therapy for venous thromboembolism. Most patients can be treated in the outpatient setting with low-molecular-weight heparin and a vitamin K antagonist (warfarin) or direct-acting oral anticoagulants.
There is no advantage to adding CT of the abdomen and pelvis to a basic screening protocol for occult malignancy in patients with unprovoked VTE.
Continuing warfarin therapy for 18 months after an unprovoked PE reduces the risk of recurrent symptomatic venous thromboembolism (VTE). However, benefit beyond 18 months is not maintained after the warfarin is discontinued.
Aspirin improves long-term cardiovascular and thrombotic outcomes in patients who have had an initial unprovoked episode of VTE. The risk of bleeding was no higher in the aspirin group, perhaps because those at risk of bleeding were “uncovered” during the initial period of anticoagulation.
This complex network meta-analysis of eight treatment regimens for acute venous thromboembolism found that a combination of unfractionated heparin and vitamin K antagonists is associated with the least effective strategy with the highest risk of recurrent events.
Catheter-directed thrombolysis for proximal DVT is experimental but may be considered in a patient with phlegmasia and resulting compartment syndrome.
Mar 1, 2015 Issue
Risk of Venous Thromboembolism with Use of Combined Oral Contraceptives [Cochrane for Clinicians]
All combined oral contraceptives increase VTE risk. The risk is greater for those containing desogestrel, drospirenone, gestodene (not available in the United States), and cyproterone acetate (not available in the United States) when compared with levonorgestrel. All combined oral contraceptives are effective in preventing pregnancy.
Aspirin is as effective as dalteparin for extended thromboprophylaxis in patients who had total hip arthroplasty and had initially received 10 days of dalteparin prophylaxis postoperatively. Because of its relative safety, low cost, and easy administration, aspirin is an attractive alternative to lo...
Use the Wells criteria to determine the likelihood of deep venous thrombosis; patients at moderate to high risk should go straight to ultrasonography. Patients at low risk should have d-dimer testing, followed by ultrasonography only if the results are positive. This approach decreases the use of d-...
Although this ASPIRE study was underpowered to detect a difference in the primary outcome, when the results were combined with those of the WARFASA trial, the data show that daily low-dose aspirin prevents recurrent VTE as well as major vascular events without increasing bleeding in patients who hav...