A Comparison of Six Weeks With Six Months of Oral Anticoagulant Therapy After a First Episode of Venous Thromboembolism

Schulman, Sam; Rhedin, Ann-Sofie; Lindmarker, Per; Carlsson, Anders; Lärfars, Gerd; Nicol, Peter; Loogna, Enno; Svensson, Else; Ljungberg, Bengt; Walter, Hans; Viering, Stanka; Nordlander, S; Leijd, Barbro; Jönsson, Klas; Hjorth, Martin; Linder, O; Boberg, J.

doi:10.1097/00006254-199601000-00015

Cited by 319 publications

(544 citation statements)

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“…Optimal duration of VKA treatment in patients with a first episode of idiopathic DVT is still a matter of debate, and current recommendations are often difficult to implement [6,15]. Assessment of individual risk of recurrent thrombosis is important as it simplifies management strategies in patients with VTE, which is especially relevant if tailored to specific groups of patients with different risks of recurrence [16].…”

Section: Discussionmentioning

confidence: 99%

“…Since the risk of recurrent VTE is believed to gradually diminish over time, many patients with idiopathic DVT may not require prolonged treatment with a vitamin K antagonist (VKA) [5,6]. According to recent guidelines, patients with unprovoked DVT should be treated for at least 3 months and should then be evaluated for the risks and benefits of long-term therapy [1]; however, identification of these patients is not always straightforward.…”

Section: Introductionmentioning

confidence: 99%

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Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

et al. 2011

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The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7% and 1.1% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4% and 10.4% in the no-RVT and RVT groups, respectively (relative risk 5 7.4; 95% confidence interval 5 4.9-9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis. Am. J. Hematol. 86:914-917, 2011. V

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

et al. 2011

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“…Six percent of recurrent episodes of venous thromboembolism are expected to be fatal (22). A small group of patients with recurrent events, perhaps 2%, will have serious permanent disability, though the majority will recover well.…”

Section: Bleeding Complication Vs Thromboembolic Complicationmentioning

confidence: 99%

Dental management of patients receiving anticoagulation or antiplatelet treatment

Pototski

Amenábar

2007

J Oral Sci

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Antiplatelet and anticoagulant agentshave been extensively researched and developed as potential therapies in the prevention and management of arterial and venous thrombosis. On the other hand, antiplatelet and anticoagulant drugs have also been associated with an increase in the bleeding time and risk of postoperative hemorrhage. Because of this, some dentists still recommend the patient to stop the therapy for at least 3 days before any oral surgical procedure. However, stopping the use of these drugs exposes the patient to vascular problems, with the potential for significant morbidity. This article reviews the main antiplatelet and anticoagulant drugs in use today and explains the dental management of patients on these drugs, when subjected to minor oral surgery procedures. It can be concluded that the optimal INR value for dental surgical procedures is 2.5 because it minimizes the risk of either hemorrhage or thromboembolism. Nevertheless, minor oral surgical procedures, such as biopsies, tooth extraction and periodontal surgery, can safely be done with an INR lower than 4.0. (J. Oral Sci. 49, [253][254][255][256][257][258] 2007)

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“…Because it is important to minimize the negative side-effects without increasing the recurrence rate, shorter durations of OAT have been evaluated. The results are inconclusive [76][77][78]. Levine et al compared 4 weeks with 3 months of coumarin in patients who had a normal impedance plethysmograph (IPG) after 4 weeks.…”

Section: 5 Duration Of Secondary Prophylaxismentioning

confidence: 99%

“…Even after normalization of the IPG 8.6% of the placebo group developed recurrent thrombosis versus 0.9% of the warfarin group. They conclude that even after nor malization of the IPG the rate of recurrent DVT after stopping OAT after 4 weeks is high [79], Schulman et al compared 6 weeks treatment with 6 months treatment in a large multicentre trial [78]. This study demonstrated a benefit of prolonged anti coagulation in the 6-month group, although the long-term outcome for all patients was discouraging since there was no difference in the incidence of recurrent events in the two groups during 24 months of follow-up after the initial episode.…”

Section: 5 Duration Of Secondary Prophylaxismentioning

confidence: 99%

New developments in the treatment of deep venous thrombosis

Janssen¹,

Nováková²,

Verbruggen³

et al. 1997

The Netherlands Journal of Medicine

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An initial course of standard heparin (SH) or low-molecular-weight heparins (LMWH) is regarded as the treatment of choice for patients with deep venous thrombosis (DVT). LMWH have better bioavailability after subcutaneous administra tion, have a longer half-life, and show higher and more predictable anticoagulant activity. As a result they can be given subcutaneously and without laboratory control, using a dose that is determined by body weight. Because of these multiple advantages of LMWH they will replace SH in the future and subsequently home treatment with LMWH of selected patients seems feasible. The currently accepted approach is to start with SH or LMWH therapy combined with oral anticoagulant therapy (OAT) at the time of diagnosis. The course of SH or LMWH should continue for at least 5 days, provided that international normalized ratio (INR) is in the therapeutic range on 2 consecutive days. OAT should be continued for at least 3 months to prolong the prothrombin time to an INR of 2 -3 . When oral anticoagulants are either contraindicated or inconvenient, SH or LMWH can be used at the middosing interval. The role of anti-platelet treatment is not yet established 4 and should be compared with coumarin therapy in the future.

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A Comparison of Six Weeks With Six Months of Oral Anticoagulant Therapy After a First Episode of Venous Thromboembolism

Cited by 319 publications

References 0 publications

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

Dental management of patients receiving anticoagulation or antiplatelet treatment

New developments in the treatment of deep venous thrombosis

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