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Malattia trombotica: condizioni cliniche ad aumentato rischio e terapia anticoagulante
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Management of recurrent venous thromboembolism in cancer patients
No full textCancer is one the most prevalent risk factors in patients diagnosed with deep vein thrombosis or pulmonary embolism. Patients with cancer and venous thromboembolism have a higher risk of mortality when compared to patients with cancer without venous thromboembolism and a higher risk of recurrent thrombosis when compared with patients with venous thromboembolism without cancer. This increased risk of recurrence is not only observed after anticoagulant treatment is stopped, but also during anticoagulant treatment. Clinical trials have shown that the use of low molecular weight heparin during the first three to six months after venous thrombosis in patients with cancer is associated with a significantly lower risk of recurrence than the use of vitamin K antagonists and, thus, low molecular weight heparin is currently recommended as the treatment of choice by international guidelines. Unfortunately, the optimal management of recurrent venous thromboembolism during anticoagulant treatment remains poorly defined. In general, patients should firstly be assessed for treatment compliance, for the occurrence of heparin-induced thrombocytopenia, and for the presence of mechanical compression from tumour masses. Possible strategies include switching to a different anticoagulant drug, in particular from vitamin K antagonists to low molecular weight heparin; increasing the dose of the anticoagulant drug; or inserting an inferior vena cava filter. The results of recent registries show that the current approach to cancer patients with recurrent venous thromboembolism in routine clinical practice is highly heterogeneous
Abdominal obesity and the risk of recurrent deep vein thrombosis
No full textBackground: Abdominal obesity has been found to be associated with an increased risk of deep vein thrombosis (DVT). Whether patients with abdominal obesity have an increased risk of recurrence is currently unknown.
Methods: Patients with objective diagnosis of DVT and a life expectancy of greater than 6 months underwent measurement of the circumference of the waist. A waist circumference of greater than 102 cm for men and greater than 88 cm for women defined abdominal obesity. Information on age, gender, and on the presence of risk factors for DVT was collected. At follow-up, all patients underwent serial compression ultrasound of the lower limbs and were clinically evaluated every 6 months.
Results: One hundred patients were enrolled, 58 with abdominal obesity and 42 without. Mean age was 64.5 and 57.3 years, respectively (p<0.05). Percentage of mate patients was 32.8% and 81.0% (p<0.01). Unprovoked DVT and transient risk factors rates were similar in both groups. Overall, recurrent DVT was documented in 29 patients, 16 in patients with abdominal obesity (27.6%) and 13 in patients without (31.0%). At the multivariate regression analysis HR for VTE recurrence in abdominal obese patients was 1.26 (95% confidence interval =0.47-3.4).
Conclusions: Abdominal obesity does not seem to modify the risk of recurrent DVT
Thalassemia trait and arterial thromboembolic events: a systematic review and a meta-analysis of the literature.
No full textOral anticoagulant therapy in patients with mechanical heart valve and intracranial haemorrhage. A systematic review
No full textOptimal timing for restarting anticoagulant therapy after intracranial bleeding is a critical issue.The purpose of this systematic review is to summarize published studies on the management of oral anticoagulant therapy after intracranial bleeding secondary to the use of vitamin K antagonists in patients with a mechanical heart valve. A computer-assisted search of the MEDLINE and EMBASE electronic databases till January 2008 was performed. Two investigators independently performed study selection and completed a predefined quality assessment and data extraction form. Main inclusion criterion was the enrolment of patients with a mechanical heart valve and intracranial haemorrhage during oral anticoagulant treatment. Any randomised controlled trial, observational cohort study, case series and reports was included. No randomised controlled trials were identified. Six observational cohort studies were included in the final analysis.All studies were of low quality.A total of 120 patients were enrolled. Anticoagulation was restarted within a broad time range (2 days to 3 months). Four ischaemic strokes and two recurrent cerebral haemorrhages occurred after anticoagulation was restarted after a mean follow-up of 7.9 months. Eighteen patients were described in the selected case reports.Anticoagulant therapy was restarted within four days to eight weeks.Two patients had a recurrent haemorrhagic event, and no ischaemic events were reported. In conclusion, restarting oral anticoagulant therapy few days and, indirectly, stopping anticoagulant therapy for a few days (even for 7-14 days) after the occurrence of cerebral haemorrhage are both safe. However, well-designed studies are strongly recommended to provide better evidence. © 2009 Schattauer GmbH
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