Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation

Riva, Nicoletta; Donadini, Marco Paolo; Ageno, Walter

doi:10.1160/th14-06-0563

Cited by 109 publications

(117 citation statements)

References 122 publications

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“…Approximately, 35% of patients with symptomatic VTE present pulmonary embolism (PE), while 65% of patients manifest only deep vein thrombosis (DVT) (2). DVT is a relatively common situation carrying serious consequences.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Attitudes and Practices of Internal Medicine Residents Towards Deep Vein Thrombosis Prophylaxis in a University Hospital in Tehran

et al. 2016

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Background: Deep Vein Thrombosis (DVT) is a major problem in hospitalized patients. There is discrepancy between healthcare providers' knowledge and their clinical practice regarding DVT prophylaxis. In this study we aimed to evaluate knowledge, attitude and practices of internal medicine residents at an educational hospital in Tehran. Methods:This cross-sectional study was conducted during December 2015 at Shariati hospital of Tehran, IRAN. A questionnaire covering five domains of clinical scenarios, adherence to guidelines, personal beliefs, practice, preferences and personal beliefs, was distributed between internal medicine residents. Medical records of patients at the internal ward were reviewed to assess the status of DVT prophylaxis in patients, who needed DVT prophylaxis based on American college of chest physicians' (ACCP) guidelines.Results: Overall, 71 residents out of 88 residents returned the questionnaire, and 43.7% were aware of the guidelines. Furthermore, 97.2% thought DVT prophylaxis is clinically important but only 66.90% of the patients, who needed DVT prophylaxis, were receiving DVT prophylaxis. More than 50% of the residents underestimated the incidence of DVT and mortality rate due to pulmonary embolism. The most common reason for not prescribing DVT prophylaxis was concern about bleeding in 53.5% of the participants. Further analysis of different components of the questionnaire showed that there is a significant association between "awareness" and "adherence" scores (P = 0.041) and correct answers to "clinical scenarios" and "practice" (P = 0.012). Conclusions:Although the level of knowledge on these clinical situations is good, underestimation of the risk of DVT development in hospitalized patients needs more attention. This might be due to low levels of awareness of presence and content of DVT prophylaxis guidelines. Programs should be designed to uphold the levels of information of DVT prophylaxis guidelines among internal medicine residents.

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Section: Introductionmentioning

confidence: 99%

Knowledge, Attitudes and Practices of Internal Medicine Residents Towards Deep Vein Thrombosis Prophylaxis in a University Hospital in Tehran

et al. 2016

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“…8,9 In a meta-analysis of the influence of obesity on the risk of a first episode of venous thromboembolism (VTE), Ageno et al 10 estimated an overall odds ratio for VTE of 2.3 (95% confidence interval, 1.7-3.2) ( Figure 1A), which is similar to other established risk factors for first VTE such as heterozygous factor V Leiden and estrogen therapy but lower than major risk factors such as surgery, hospitalization, cancer, or major trauma. 4 Analysis of data from the Atherosclerosis Risk in Communities and the Cardiovascular Health Study generated a similar hazard ratio of 2.2 for VTE among patients with obesity (BMI $30 kg/m 2 ) and a slightly higher hazard ratio of 2.7 for patients with severe (class III) obesity (BMI $40 kg/m 2 ).…”

Section: Obesitymentioning

confidence: 90%

“…3,4 Hematology consultants are often asked to provide recommendations regarding the prevention and management of thrombosis in such patients for whom evidence-based guidelines may not be available. This chapter will update the management of adult patients at risk for thrombosis as a result of obesity or IBD as exemplars of chronic prothrombotic inflammatory conditions.…”

Section: Inflammation As a Trigger Of Thrombosismentioning

confidence: 99%

Thrombosis in the setting of obesity or inflammatory bowel disease

Lentz

2016

Blood

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Obesity and inflammatory bowel disease (IBD) are systemic inflammatory disorders that predispose to arterial and venous thrombosis through similar prothrombotic mechanisms. Obesity and IBD are chronic risk factors that lead to a persistently elevated risk of thrombosis, although the thrombotic risk with IBD appears to wax and wane with disease severity. Because of the lack of high-quality evidence to guide management decisions, approaches to the prevention and treatment of thrombosis in patients with obesity or IBD are based on extrapolation from general guidelines for antithrombotic therapy. Obesity alters the pharmacokinetics of some anticoagulant drugs, and IBD patients present the added management challenge of having a high risk of gastrointestinal bleeding while taking anticoagulants. An extended duration of anticoagulant therapy is often recommended for obese or IBD patients with unprovoked venous thromboembolism unless there is a high risk of bleeding, although more data and better biomarkers are needed to determine whether anticoagulation can be safely stopped in a subset of IBD patients during remission of active disease. Most patients with obesity or IBD require thromboprophylaxis in conjunction with hospitalization or surgery, with adjustment of anticoagulant dosing in patients with severe obesity.

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“…1 On the other hand, when the thrombotic process occurs in the vein bed, where it is triggered by stasis and inflammation, the coagulation cascade is much more involved than platelets: the final thrombus, macroscopically red, will be formed mainly by fibrin with platelets entrapped in it. 2 This is the main reason why antiplatelet treatment has a key role in atherothrombotic diseases such as myocardial infarction and stroke, while anticoagulants are much more indicated in the prevention of cardioembolic stroke and systemic embolism complicating atrial fibrillation. The combination of antiplatelet and anticoagulant agents is indicated in different clinical settings: some examples are the acute phase of an acute coronary syndrome (parenteral anticoagulants in combination with antiplatelets) or the long-term treatment of patients with atrial fibrillation who undergo percutaneous coronary interventions (PCIs).…”

Section: Introductionmentioning

confidence: 99%

Antiplatelet and antithrombotic treatment for secondary prevention in ischaemic heart disease

Lettino

Leonardi

Maria

et al. 2017

Eur J Prev Cardiolog

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Platelets play a key role in the pathogenesis of acute coronary syndromes and this is why antiplatelet drugs are essential, both in the acute phase and in the long-term follow-up in preventing recurrent myocardial infarction, stroke and cardiovascular death. Aspirin is the most used agent and still remains the first choice drug for lifelong administration in secondary prevention after myocardial infarction. Dual antiplatelet therapy, targeting more than one pathway of platelet activation, has significantly improved the outcome of patients with acute coronary syndromes despite an increased risk of bleeding complications. The aim of this article is to provide an overview of the evidence from randomized clinical trials with a focus on the best association between aspirin and a P2Y 12 inhibitor such as clopidogrel, prasugrel or ticagrelor, on the selection of the appropriate agent based on the revascularization strategy and on the optimal duration of such an intensive treatment. We will also provide the latest evidence regarding new antithrombotic agents, such as vorapaxar or low dose rivaroxaban, that could be associated with dual antiplatelet therapy in high risk patients with the aim of further reducing the rate of major ischaemic complications. Finally we will address the issue of patients presenting with atrial fibrillation and a concomitant acute coronary syndrome who frequently need a percutaneous coronary intervention, with a specific focus on the combination therapy of antiplatelet and anticoagulant agents and on the current recommendations of the guidelines.

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Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation

Cited by 109 publications

References 122 publications

Knowledge, Attitudes and Practices of Internal Medicine Residents Towards Deep Vein Thrombosis Prophylaxis in a University Hospital in Tehran

Knowledge, Attitudes and Practices of Internal Medicine Residents Towards Deep Vein Thrombosis Prophylaxis in a University Hospital in Tehran

Thrombosis in the setting of obesity or inflammatory bowel disease

Antiplatelet and antithrombotic treatment for secondary prevention in ischaemic heart disease

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