1,721,015 research outputs found
Antiphospholipid Syndrome: A Challenging Hypercoagulable State with Systemic Manifestations
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Initial and Long-Term Treatment of Pulmonary Embolism: Current Approach and Future Perspectives
No full textPulmonary embolism is associated with variable risk of early mortality, ranging from less than 1% to more than 15%. Risk stratification, based on clinical variables and signs of right ventricular dysfunction, is crucial to decide the best management and treatment strategy. Home therapy may be an option for low-risk patients, whereas patients at intermediate risk need to be hospitalized and some of them, at intermediate high risk, may require more intensive monitoring to early detect signs of haemodynamic decompensation. The initial treatment is based on anticoagulants with rapid onset of action, either parenteral (heparin/fondaparinux) or oral (direct oral anticoagulants, DOACs). Thereafter, DOACs (or, if contraindicated, vitamin K antagonists) needs to be continued for at least 3 months. Beyond this period, an individual re-evaluation of the risk-to-benefit ratio of anticoagulation should be performed, based on several factors, including the type of index event, age, sex, D-dimer and residual venous obstruction. Possibly safer strategies can be offered to higher risk patients requiring extended duration of treatment, including the DOACs apixaban and rivaroxaban at reduced dose
Combined warfarin-aspirin therapy: what is the evidence for benefit and harm and which patients should (and should not) receive it?
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Factor XI inhibitors for the prevention of cardiovascular disease: A new therapeutic approach on the horizon?
No full textAnticoagulant drugs that are currently used to prevent and/or treat thrombosis have some limitations that hinder their ability to meet specific clinical requirements. While these drugs effectively reduce the rates of thrombotic events, they simultaneously increase the risk of bleeding. Moreover, their risk-to-benefit balance is problematic in some patients, such as those with severe chronic kidney disease or those at high bleeding risk. A novel anticoagulation method, FXI inhibition has emerged as a promising alternative. It demonstrates a strong rationale for the prevention and treatment of venous thromboembolism and the potential fulfillment of unmet clinical needs in the cardiovascular field. A number of FXI inhibitors are currently undergoing clinical investigation. The objective of this review is to provide an overview of early results of research on FXI inhibitors in the cardiovascular setting, offering valuable insights into their potential role in shaping the future of anticoagulation
Geographical and ethnoracial differences in venous thromboembolism and anticoagulation: An expanding horizon
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Certoparin for the treatment and prevention of thrombosis: pharmacological profile and results from clinical studies
No full textIntroduction: Several low-molecular-weight heparins are available for the prevention and treatment of venous thromboembolism and arterial thrombosis. Certoparin has been extensively tested in different clinical settings for about 20 years. Areas covered: The authors provide a drug evaluation based on literature searches performed through Medline. Specifically, the authors review studies on the pharmacological characteristics of certoparin and the clinical trial and post-marketing studies in the field of venous thromboembolism. Furthermore, the authors also review the available smaller studies performed in clinical settings for indications such as stroke, atrial fibrillation, and hemodialysis. Expert opinion: Certoparin has proved to be effective and safe therapy for preventing venous thromboembolism in different surgical and medical settings. With regards to DVT treatment, certoparin shows the peculiar feature of being used at a fixed, weight-independent dose (subcutaneous 8000 IU twice daily). Unfortunately, certoparin has no specific data from clinical trials on treatment of pulmonary embolism. Furthermore, certoparin has not been specifically tested in unusual site thrombosis. Certoparin represents a valid option for venous thromboembolism prevention and DVT treatment. Further studies are also required to provide data on the use of certoparin to treat acute pulmonary embolisms and to further substantiate results on atrial fibrillation and bridging therapy
Optimal treatment duration of venous thrombosis
No full textRandomized controlled trials have shown that patients with venous thromboembolism benefit from a minimum of three months of anticoagulant therapy. After this period, it was suggested that patients with an expected annual recurrence rate of < 5% could safely discontinue treatment. Using a population-based approach for stratification, these patients are those with major transient risk factors, and represent the minority. For all other patients, including those with previous episodes of venous thromboembolism, cancer, or unprovoked events, this treatment duration may not be sufficiently protective. Because extending anticoagulation for additional three to nine months does not result in further, long-term reduction of recurrences, indefinite treatment duration should be considered. However, case-fatality rate for major bleeding in patients taking warfarin for more than three months is higher than case-fatality rate of recurrent venous thromboembolism. Thus, an individual patient approach to improve and increase the identification of those who can safely discontinue treatment at three months becomes necessary. Clinical prediction rules or management strategies based on D-dimer levels or residual vein thrombosis have been proposed and need further refinement and validation. Specific bleeding scores are lacking. Meanwhile, the oral direct inhibitors have been proposed as potential alternatives to the vitamin K antagonists, and aspirin may provide some benefit in selected patients who discontinue anticoagulation. Deep vein thrombosis in unusual sites is associated with less, but potentially more severe recurrences, in particular in patients with splanchnic vein thrombosis who also face an increased risk of bleeding complications while on treatment
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