Antithrombotic Therapy for Venous Thromboembolic Disease

Hyers, Thomas M.; Agnelli, Giancarlo; Hull, Russell D.; Weg, John G.; Morris, Timothy A.; Samama, M; Tapson, Victor F.

doi:10.1378/chest.114.5_supplement.561s

Cited by 224 publications

(153 citation statements)

References 224 publications

Supporting

Mentioning

143

Contrasting

Unclassified

Order By: Relevance

“…Na EP, os estudos, apesar de em menor número, apontam na mesma direção, tornando o uso das HBPM uma opção terapêutica 75,76 . A permanência em ambiente hospitalar dos pacientes tratados com HBPM tem sido orientação de alguns estudos, porém, em outros, o tratamento ambulatorial é recomendado 77 . A dose das HBPM dependerá da sua forma de apresentação e deverá ser individualizada 78 .…”

Section: Heparina De Baixo Peso Molecular (Hbpm)unclassified

See 1 more Smart Citation

Diretriz de Embolia Pulmonar

Volschan¹,

Caramelli²,

Gottschall³

et al. 2004

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Section: Heparina De Baixo Peso Molecular (Hbpm)unclassified

“…A estratégia terapêutica para os casos de trombofilia é individualizada de acordo com a situação clínica 77 .…”

Section: Anticoagulantes Oraisunclassified

Diretriz de Embolia Pulmonar

Volschan¹,

Caramelli²,

Gottschall³

et al. 2004

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

“…APTT is sensitive to the inhibitory effects of SH on throm bin, factor Xa and factor IXa. In clinical practice SH is adjusted to maintain the APTT response between an (empirically stated) therapeutic range-i.e., 1.5 and 2.5 times the control value, which is equivalent to a heparin level of 0.2 to 0.4 U /m l by protamine titration [7,8]. For this purpose a nomogram has been developed which results in achieving a therapeutic APTT at 24 and 48 h in a large proportion of patients and in reduced periods of inadequate anticoagulation during SH therapy [9].…”

Section: L Standard Unfractionated Heparin (Sh)mentioning

confidence: 99%

“…The risk of bleeding is increased with an increased heparin dose, but also other factors such as recent surgery, trauma, peptic ulcer, malignancy or an haemostatic abnormality are important. Most tri als comparing SH to LMWH suggest that LMWH 40 Medicine 50(19971 36-45 cause fewer bleeding complications [20,[39][40][41], This embolism despite anticoagulation [8,62,63]. No data is probably due to a lower anti-IIa/anti-Xa ratio of LMWH than of SH.…”

Section: Side-effectsmentioning

confidence: 99%

New developments in the treatment of deep venous thrombosis

Janssen¹,

Nováková²,

Verbruggen³

et al. 1997

The Netherlands Journal of Medicine

View full text Add to dashboard Cite

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.

show abstract

“…[1][2][3][4][5][6][7] Extended or long-term therapy with LMWH is indicated in patients who are unable to safely take or tolerate other oral anticoagulants 2,[6][7][8][9][10][11] and in cancer patients, as long-term LMWH has demonstrated superiority for reduction in VTE recurrence and mortality. [12][13][14] Studies assessing the safety of long-term LMWH against oral vitamin K antagonists (VKAs) or novel anticoagulants in cancer or other populations were designed to address more common side effects: the risk of bleeding and thrombocytopenia.…”

Section: Introductionmentioning

confidence: 99%

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

et al. 2016

View full text Add to dashboard Cite

BACKGROUND: Adults who require long-term anticoagulation with low-molecular-weight heparin (LMWH) such as cancer patients or the elderly may be at increased risk of fractures. OBJECTIVE: To determine the effects of LMWH therapy of at least 3 months' duration on fractures and bone mineral density (BMD) in non-pregnant adult populations. METHODS: We systematically reviewed electronic databases (e.g., MEDLINE, EMBASE), conferences and bibliographies until June 2015 and included comparative studies in non-pregnant adult populations that examined the effects of LMWH (≥3 months) on fractures and BMD. We synthesized evidence qualitatively and used random-effects meta-analysis to quantify the effect of LMWH on fractures. RESULTS: Sixteen articles reporting 14 studies were included: 10 clinical trials (n = 4865 participants) and four observational cohort studies (3 prospective, n = 221; 1 retrospective, n = 30). BMD and fractures were secondary outcomes in the majority of trials, while they were primary outcomes in the majority of observational studies. In participants with venous thromboembolism and underlying cardiovascular disease or cancer (5 RCTs, n = 2280), LMWH for 3-6 months did not increase the relative risk of all fractures at 6-12 months compared to unfractionated heparin, oral vitamin K antagonists or placebo [pooled risk ratio (RR) = 0.58, 95 % CI: 0.23-1.43; I 2 = 12.5 %]. No statistically significant increase in the risk of fractures at 6-12 months was found for cancer patients (RR = 1.08, 95 % CI: 0.31-3.75; I 2 = 4.4 %). Based on the data from two prospective cohort studies (n = 166), LMWH for 3-24 months decreased mean BMD by 2.8-4.8 % (depending on the BMD site) compared to mean BMD decreases of 1.2-2.5 % with oral vitamin K antagonists. CONCLUSIONS: LMWH for 3-6 months may not increase the risk of fractures, but longer exposure for up to 24 months may adversely affect BMD. Clinicians should consider monitoring BMD in adults on long-term LMWH who are at increased risk of bone loss or fracture.

show abstract

Antithrombotic Therapy for Venous Thromboembolic Disease

Cited by 224 publications

References 224 publications

Diretriz de Embolia Pulmonar

Diretriz de Embolia Pulmonar

New developments in the treatment of deep venous thrombosis

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

Contact Info

Product

Resources

About