1,721,103 research outputs found
Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism
No full textIt takes about 3 months to complete active treatment of venous thromboembolism (VTE), with further treatment serving to prevent new episodes of thrombosis (pure secondary prevention). Consequently, VTE should generally be treated for either 3 months or indefinitely (exceptions will be described in the text). The decision to stop anticoagulants at 3 months or to treat indefinitely is dominated by the long-term risk of recurrence, and secondarily influenced by the risk of bleeding and by patient preference. VTE provoked by a reversible risk factor, or a first unprovoked isolated distal (calf) deep vein thrombosis (DVT), has a low risk of recurrence and is usually treated for 3 months. VTE associated with active cancer, or a second unprovoked VTE, has a high risk of recurrence and is usually treated indefinitely. The decision to stop anticoagulants at 3 months or to treat indefinitely is more finely balanced after a first unprovoked proximal DVT or pulmonary embolism (PE). Indefinite anticoagulation is often chosen if there is a low risk of bleeding, whereas anticoagulation is usually stopped at 3 months if there is a high risk of bleeding. The decision to continue anticoagulation indefinitely after a first unprovoked proximal DVT or PE is strengthened if the patient is male, the index event was PE rather than DVT, and-or D-dimer testing is positive 1 month after stopping anticoagulant therapy. © 2014 by The American Society of Hematology.Adam SS, 2012, ANN INTERN MED, V157, P796, DOI 10.7326-0003-4819-157-10-201211200-00532; Agnelli G, 2003, ANN INTERN MED, V139, P19; Agnelli G, 2013, NEW ENGL J MED, V368, P699, DOI 10.1056-NEJMoa1207541; Agnelli G, 2001, NEW ENGL J MED, V345, P165, DOI 10.1056-NEJM200107193450302; Akl EA, 2011, COCHRANE DB SYST REV, DOI 10.1002-14651858.CD006650.pub3; Baglin T, 2012, J Thromb Haemost, V10, P698, DOI 10.1111-j.1538-7836.2012.04662.x; Baglin T, 2010, J THROMB HAEMOST, V8, P2436, DOI 10.1111-j.1538-7836.2010.04022.x; Bauersachs R, 2010, NEW ENGL J MED, V363, P2499, DOI 10.1056-NEJMoa1007903; Becattini C, 2012, NEW ENGL J MED, V366, P1959, DOI 10.1056-NEJMoa1114238; Bochenek T, 2012, THROMB HAEMOSTASIS, V107, P699, DOI 10.1160-TH11-08-0565; 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Shorter or longer anticoagulation to prevent recurrent venous thromboembolism: Systematic review and meta-analysis
No full textIntroduction: Venous thromboembolism (VTE) is a major disease associated with short-term and longterm morbidity and mortality. Patients with a VTE provoked by surgery or immobilisation are at low risk of recurrence and do not require long-term anticoagulation; those with a VTE and metastatic cancer are at high risk of recurrence and require lifetime thromboprophylaxis. In those at intermediate risk of recurrence, it remains controversial whether prolonging anticoagulation and thus incurring treatment burden and bleeding risk is warranted. Methods and analysis: We will conduct a systematic review and meta-analysis of randomised controlled trials enrolling patients with VTE at intermediate risk of recurrence and evaluating short-term anticoagulation (12 weeks to 9 months initial therapy) versus longer term anticoagulation (at least 6 months additional anticoagulation beyond the course of treatment in the shorter arm). Anticoagulation could consist of vitamin K antagonists or new oral anticoagulants. Outcomes of interest include recurrent non-fatal thrombosis (deep venous thrombosis and pulmonary embolism), major non-fatal bleeding and mortality. We will systematically search CINAHL, EMBASE, MEDLINE and the Cochrane Central Registry of Controlled Trials. Teams of two reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently abstract data and assess risk of bias in eligible trials. We will conduct meta-analyses to establish the effect of shortterm versus long-term anticoagulation on the outcomes of interest and evaluate confidence in estimates (quality of evidence) using the GRADE (grading of recommendations, assessment, development and evaluation) approach. Ethics and dissemination: Our review will facilitate evidence-based management of patients with unprovoked or recurrent VTE. For purposes of privacy and confidentiality, the systematic review will be limited to studies with deidentified data. The study will be disseminated by peer-review publication and conference presentation. Trial registration number: PROSPERO (CRD42014007620).Akl EA, 2013, PLOS ONE, V8, DOI 10.1371-journal.pone.0057132; Akl EA, 2012, J CLIN EPIDEMIOL, V65, P262, DOI 10.1016-j.jclinepi.2011.04.015; Altman DG, 2003, BRIT MED J, V326, P219, DOI 10.1136-bmj.326.7382.219; Atkins D, 2004, BRIT MED J, V328, P1490; Boutitie F, 2011, BRIT MED J, V342, DOI 10.1136-bmj.d3036; British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group, 2003, THORAX, V58, P470; Busse JW, 2013, MODIFICATION COCHRAN; Carrier M, 2010, ANN INTERN MED, V152, P578, DOI 10.7326-0003-4819-152-9-201005040-00008; East AT, 2010, SEMIN VASC SURG, V23, P182, DOI 10.1053-j.semvascsurg.2010.05.006; Guyatt G, 2013, J CLIN EPIDEMIOL, V66, P151, DOI 10.1016-j.jclinepi.2012.01.006; Guyatt GH, 2013, J CLIN EPIDEMIOL, V66, P158, DOI 10.1016-j.jclinepi.2012.01.012; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P1283, DOI 10.1016-j.jclinepi.2011.01.012; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P1277, DOI 10.1016-j.jclinepi.2011.01.011; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P1303, DOI 10.1016-j.jclinepi.2011.04.014; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P407, DOI 10.1016-j.jclinepi.2010.07.017; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P1294, DOI 10.1016-j.jclinepi.2011.03.017; Guyatt GH, 2008, BRIT MED J, V336, P924, DOI 10.1136-bmj.39489.470347.AD; Holbrook A, 2012, CHEST S, V141, pe152S, DOI DOI 10.1378-CHEST.11-2295; Kearon C, 2008, CHEST, V133, p454S, DOI 10.1378-chest.08-0658; Kearon C, 2012, J THROMB HAEMOST, V10, P507, DOI 10.1111-j.1538-7836.2012.04629.x; Kearon C, 2012, CHEST, V141, DOI [10.1378-chest.11-2301, DOI 10.1378-CHEST.11-2301]; Kearon C, 2010, J THROMB HAEMOST, V8, P2313, DOI 10.1111-j.1538-7836.2010.03991.x; McManus RJ, 2011, CLIN EVID, V2011, P0208; Naess IA, 2007, J THROMB HAEMOST, V5, P692; National Guideline C. Prevention and management of venous thromboembolism, PREV MAN VEN THROMB; Orwin RG, 1994, HDB RES SYNTHESIS, P139; Prandoni P, 1997, HAEMATOLOGICA, V82, P423; Prandoni P, 2007, HAEMATOL-HEMATOL J, V92, P199, DOI 10.3324-haematol.10516; Rodger MA, 2008, CAN MED ASSOC J, V179, P417, DOI 10.1503-cmaj.080493; van Dongen CJJ, 2003, ARCH INTERN MED, V163, P1285, DOI 10.1001-archinte.163.11.12850
Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization.
No full textCategorization of patients as having provoked or unprovoked venous thromboembolism: Guidance from the SSC of ISTH
No full textRisk of Recurrence After a First Episode of Symptomatic Venous Thromboembolism Provoked by a Transient Risk Factor A Systematic Review
No full textBACKGROUND: We aimed to determine the risk of recurrence for symptomatic venous thromboembolism (VTE) provoked by different transient risk factors.
DATA SOURCES: MEDLINE, EMBASE, and Cochrane Collaboration Registry of Randomized Trials databases were searched.
STUDY SELECTION: Prospective cohort studies and randomized trials of patients with a first episode of symptomatic VTE provoked by a transient risk factor and treated for at least 3 months were identified.
DATA EXTRACTION: Number of patients and recurrent VTE during the 0- to 12-month and 0- to 24-month intervals after stopping therapy, study design, and provoking risk factor characteristics were extracted.
DATA SYNTHESIS: Annualized recurrence rates were calculated and pooled across studies. At 24 months, the rate of recurrence was 3.3% per patient-year (11 studies, 2268 patients) for all patients with a transient risk factor, 0.7% per patient-year (3 studies, 248 patients) in the subgroup with a surgical factor, and 4.2% per patient-year (3 studies, 509 patients) in the subgroup with a nonsurgical factor. In the same studies, the rate of recurrence after unprovoked VTE was 7.4% per patient-year. The rate ratio for a nonsurgical compared with a surgical factor was 3.0 and for unprovoked thrombosis compared with a nonsurgical factor was 1.8 at 24 months.
CONCLUSIONS: The risk of recurrence is low if VTE is provoked by surgery, intermediate if provoked by a nonsurgical risk factor, and high if unprovoked. These risks affect whether patients with VTE should undergo short-term vs indefinite treatment
VENOUS THROMBOEMBOLISM RECURRENCE AFTER A FIRST EPISODE OF PROVOKED VENOUS THROMBOSIS DUE TO A TRANSIENT RISK FACTOR. A SYSTEMATIC REVIEW OF THE LITERATURE
No full textGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials.
No full textCategorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH
No full text[No abstract available
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