Clinical Risk Factors and Timing of Recurrent Venous Thromboembolism During the Initial 3 Months of Anticoagulant Therapy

Douketis, James D.; Foster, Gary; Crowther, Mark; Prins, Martin H.; Ginsberg, Jeffrey S.

doi:10.1001/archinte.160.22.3431

Cited by 234 publications

(143 citation statements)

References 50 publications

(53 reference statements)

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“…14 Furthermore, the type of venous thromboembolism at presentation was also found to be a significant predictor of PE recurrence. [13][14][15][16][17] Interestingly, recent surgery was a negative prognostic factor for fatal PE. Although this result may have been due to chance, because it was not confirmed on the validation dataset, its predictive value as a parameter was previously reported for venous thromboembolic recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism

et al. 2008

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Background— Clinical predictors for fatal pulmonary embolism (PE) in patients with venous thromboembolism have never been studied. Methods and Results— Using data from the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry about patients with objectively confirmed symptomatic acute venous thromboembolism, we determined independent predictive factors for fatal PE. Between March 2001 and July 2006, 15 520 consecutive patients (mean age±SD, 66.3±16.9 years; 49.7% men) with acute venous thromboembolism were included. Symptomatic deep-vein thrombosis without symptomatic PE was observed in 58.0% (n=9008) of patients, symptomatic nonmassive PE in 40.4% (n=6264), and symptomatic massive PE in 1.6% (n=248). At 3 months, the cumulative rates of overall mortality and fatal PE were 8.65% and 1.68%, respectively. On multivariable analysis, patients with symptomatic nonmassive PE at presentation exhibited a 5.42-fold higher risk of fatal PE compared with patients with deep-vein thrombosis without symptomatic PE ( P <0.001). The risk of fatal PE was multiplied by 17.5 in patients presenting with a symptomatic massive PE. Other clinical factors independently associated with an increased risk of fatal PE were immobilization for neurological disease, age >75 years, and cancer. Conclusion— PE remains a potentially fatal disease. The clinical predictors identified in the present study should be included in any clinical risk stratification scheme to optimally adapt the treatment of PE to the risk of the fatal outcome.

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Section: Discussionmentioning

confidence: 99%

“…Available studies in this setting are few, generally small or retrospective, or do not analyze this specific outcome. 3,[13][14][15][16][17] …”

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confidence: 99%

Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism

et al. 2008

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“…22 During the first three months of treatment, 28 (3%) patients experienced major bleeding and 58 (6%) patients had a recurrent event while taking an anticoagulant. These treatment failures predominantly occurred during the first weeks after treatment was started: 75% (21/28) of major bleeding complications and 72% (42/58) of recurrent events occurred within three weeks.…”

Section: How Can Prognostic Scores For Short-term Risk Guide Practice?mentioning

confidence: 99%

Managing pulmonary embolism using prognostic models: future concepts for primary care

Geersing

Oudega²,

Hoes³

et al. 2011

CMAJ

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“…20 Phase 2 VTE treatment studies with rivaroxaban and apixaban not only helped to identify the dose to be carried into phase 3 but also provided reassurance that an all-oral approach was possible from the start. 21,22 Consequently, the EINSTEIN and AMPLIFY trials used oral regimens that started with more intensive therapy; with rivaroxaban, this involved administering 15 mg twice daily for 3 weeks followed by 20 mg daily thereafter, whereas the apixaban regimen consisted of 10 mg twice daily for Interactions Multiple P-gp 3A4/P-gp 3A4/P-gp P-gp OD, once daily; BID, twice daily; P-gp, P-glycoprotein; VKORC1, C1 subunit of the vitamin K epoxide reductase enzyme; 3A4, cytochrome P 450 3A4 isoenzyme.…”

Section: Initial and Long-term Vte Treatmentmentioning

confidence: 99%

Evolving use of new oral anticoagulants for treatment of venous thromboembolism

Yeh

Gross

Weitz

2014

Blood

117

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The new oral anticoagulants (NOACs), which include dabigatran, rivaroxaban, apixaban, and edoxaban, are poised to replace warfarin for treatment of the majority of patients with venous thromboembolism (VTE). With a rapid onset of action and the capacity to be administered in fixed doses without routine coagulation monitoring, NOACs streamline VTE treatment. In phase 3 trials in patients with acute symptomatic VTE, NOACs have been shown to be noninferior to conventional anticoagulant therapy for prevention of recurrence and are associated with less bleeding. Rivaroxaban and dabigatran are already licensed for VTE treatment in the United States, and apixaban and edoxaban are under regulatory consideration for this indication. As the number of approved drugs increases, clinicians will need to choose the right anticoagulant for the right VTE patient. To help with this decision, this review (1) compares the pharmacologic profiles of the NOACs, (2) outlines the unique design features of the phase 3 trials that evaluated the NOACs for VTE treatment, (3) reviews the results of these trials highlighting similarities and differences in the findings, (4) provides perspective about which VTE patients should receive conventional treatment or are candidates for NOACs, and (5) offers suggestions about how to choose among the NOACs.

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Clinical Risk Factors and Timing of Recurrent Venous Thromboembolism During the Initial 3 Months of Anticoagulant Therapy

Cited by 234 publications

References 50 publications

Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism

Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism

Managing pulmonary embolism using prognostic models: future concepts for primary care

Evolving use of new oral anticoagulants for treatment of venous thromboembolism

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