1,721,111 research outputs found
Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: Risk Factors and Prevention
No full textAmbulatory cancer patients undergoing chemotherapy are at a substantial risk for venous thromboembolism (VTE) over the course of therapy and beyond it. Factors accounting for this risk include the activation of extrinsic and intrinsic coagulation pathways, platelet activation, impaired fibrinolysis, use of catheters, infusion of blood products, and thrombogenic potential of several chemotherapeutic drugs. A few stratification models can help identify patients at a higher risk of chemotherapy-associated VTE, who may benefit from preventive strategies. Although low-molecular-weight heparins (LMWHs) effectively reduce the risk of VTE, current guidelines recommend against their routine use. Based on the results of recent randomized controlled clinical trials, the administration of prophylactic doses of the novel direct oral anticoagulants (DOACs) to ambulatory cancer patients undergoing chemotherapy has the potential to offer an effective and safe protection against VTE, obviating the inconveniences of heparins. Except for patients in whom the novel drugs are unsuitable or are contraindicated, in all other patients LMWHs should be replaced by low-dose DOACs
Treatment of Refractory/High-Risk Pregnancies With Antiphospholipid Syndrome: A Systematic Review of the Literature
Full text linkDifferent treatment protocols have been employed to manage heparin/low-dose aspirin refractory or high-risk pregnancies in antiphospholipid antibody syndrome (APS) pregnancies. A systematic review of the literature on additional treatments used in refractory and/or high-risk APS pregnancies was conducted. Records from February 2006 to October 2021 were retrieved from PubMed, Web of Science, Cochrane, and the www.clinicaltrials.gov platform. Twenty-one studies met our eligibility criteria. Live birth rate is this study’s primary endpoint, while pregnancy complications and adverse events are secondary endpoints. A total of 434 pregnancies, 162 (37.3%) refractory and 272 (62.7%) high-risk/refractory pregnancies, were included. Both IVIG <2 gr/kg/monthly/HCQ/LDS and PEX/IA ± LDS led to 100% viable infants in refractory APS. Furthermore, HCQ 200–400 mg showed a higher live birth rate than HCQ + LDS (88.6% vs. 82.7%). Following treatment protocol with HCQ 200–400 mg and IVIG <2 gr/kg/monthly/HCQ/LDS, pregnancy complications rates of 16.7 and 83.3% were registered, respectively. Pravastatin 20 mg, IA weekly + IVIG 2 gr/monthly, and PEX weekly + IVIg 2 gr/kg/monthly showed higher live birth rates in high-risk APS pregnancies of 100, 100 and 92%, respectively, whereas the lower severe pregnancy complications were reported in pregnancies treated with PEX weekly + IVIg 2 gr/kg/monthly (11.1%). One (0.6%) case of dermatitis during treatment with HCQ was observed. The results of this study showed that HCQ 200–400 mg and PEX weekly + IVIG 2 gr/kg/monthly achieved a higher live birth rate in refractory APS and high-risk/refractory APS, respectively. The results presented provide clinicians with up-to-date knowledge in the management of APS pregnancies according to risk stratification
Venous Thromboembolism in Children: The Rivaroxaban Experience
No full text: The incidence of venous thromboembolism (VTE) in the pediatric population has increased more than 10-fold in the last 20 years, as a consequence of the advancement of resuscitation and surgical techniques and the global increase in life expectancy of children suffering from chronic pathologies. Monitoring anticoagulant therapy to achieve outcomes within the target range in childhood VTE, parenteral administration of medications, and frequent blood tests in children are often cumbersome. Availability of safe and effective oral agents with pediatric data to support use would be of clear benefit. A physiologically based pharmacokinetic model was developed to estimate the appropriate dosing schedule for rivaroxaban in children. This incorporated growth/maturation and variability in anthropometrics (e.g., body height, weight, and body mass index), anatomy (e.g., organ weight), physiology (e.g., blood flow rates), metabolism and excretion. Rivaroxaban use in pediatric population underwent a complete investigational program, consisting mainly of one phase I pharmacokinetics/pharmacodynamics trial, three phase II trials, one phase III trial. The phase III trial enrolled 500 patients from birth to <18 years and documented the efficacy and safety of rivaroxaban regimens at dose equivalent to the adult 20 mg dose for the prevention of fatal or symptomatic nonfatal recurrent VTE and major bleeding versus heparin or vitamin K antagonists. Results were similar to those in rivaroxaban studies in adults. The efficacy and safety of rivaroxaban in children reported in the EINSTEIN JUNIOR trial provide further support to previous trials in adults (EINSTEIN Program), which demonstrate a favorable profile for the use of rivaroxaban for the management of VTE in challenging patient populations. Other clinical evidence contributing to the use of rivaroxaban among different risk groups in pediatric VTE population confirms the consistency with principal trial. Our review aims to describe the rationale for using rivaroxaban oral suspension in clinical practice and to summarize its multiple indications in each vascular bed (e.g., cerebral venous thrombosis, symptomatic or asymptomatic central venous catheter-associated thrombosis), etiology, and patients setting
Haemostatic Balance and Transfusion Strategies in Acute Liver Failure and Acute‐On‐Chronic Liver Failure: A Systematic Review
No full textResponse to: “Procedural bleeding in patients with cirrhosis: from prediction towards prevention”
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Critical Review of International Clinical Practice Guidelines Recommendations for Prevention, Diagnosis, and Management of Central Venous Catheter Thrombosis
No full textCentral venous catheters (CVCs) are widely used in clinical practice for the administration of medications, parenteral nutrition, and hemodynamic monitoring. However, their use is associated with a significant risk of thrombosis, which can lead to serious complications, including catheter dysfunction, infection, and embolism. Numerous international clinical practice guidelines (CPGs) have been developed to address the prevention, diagnosis, and management of CVC-related thrombosis. This critical review aims to evaluate and compare the recommendations provided by these guidelines, highlighting areas of consensus, variation, and potential gaps. We systematically analyzed CPGs from major healthcare organizations, focusing on key aspects such as risk stratification, prophylactic strategies, diagnostic algorithms, and therapeutic interventions. Although most guidelines emphasize the importance of risk assessment and early intervention, there are notable discrepancies in recommendations regarding the use of anticoagulant prophylaxis, imaging modalities for diagnosis, and the duration of anticoagulation therapy. Additionally, the review explores the evidence underpinning these recommendations and identifies areas where robust clinical data are lacking. Our analysis underscores the need for harmonization across guidelines to ensure consistent and evidence-based care. Furthermore, we advocate for the development of multidisciplinary approaches to enhance decision-making and optimize clinical outcomes in this domain. By addressing the gaps and inconsistencies in current CPGs, this review seeks to provide a framework for improving the prevention, diagnosis, and management of CVC-related thrombosis, ultimately enhancing patient outcomes and reducing the healthcare burden
Short-term exposure to high levels of air pollution (nickel) and the risk of acute unprovoked proximal deep vein thrombosis in the legs
No full textManagement of Anticoagulant Therapy in Athletes and Sportspeople: Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies (FCSA) Position Paper
No full textThis position paper offers expert guidance on managing anticoagulant therapy in athletes and sportspeople, addressing the unique challenges posed by the dual need for effective thromboprophylaxis and maintenance of athletic performance. Recognizing that conditions such as atrial fibrillation and venous thromboembolism occur with higher prevalence in athletes due to factors like intense physical training, dehydration, trauma, and long-haul travel, the paper reviews current literature and expert opinions from the Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies. The manuscript highlights that although direct oral anticoagulants (DOACs) are generally preferred for their favorable efficacy and safety profile compared with traditional vitamin K antagonists (VKAs), their use in sports demands careful risk stratification. To balance effective anticoagulation with the risk of bleeding, individualized treatment strategies—including intermittent dosing regimens with DOACs—are suggested. These strategies aim to minimize bleeding risk during periods of high physical demand while preserving therapeutic effectiveness. In athletes requiring VKA therapy, sport participation—especially contact or high-impact activities—should be strongly discouraged due to the inability to manage bleeding and thrombotic risks safely. Moreover, the paper emphasizes the importance of periodic reassessment of thromboembolic and hemorrhagic risks, multidisciplinary collaboration among cardiologists, hematologists, and sports medicine specialists, and shared decision-making with the athlete. By offering practical suggestions on treatment modifications, return-to-play protocols, and patient education, this position paper serves as a critical resource for clinicians striving to optimize anticoagulant therapy in athletic populations without compromising competitive performance
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