scholarly journals PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2128
Author(s):  
Antoni Riera-Mestre ◽  
Luis Jara-Palomares ◽  
Ramón Lecumberri ◽  
Javier Trujillo-Santos ◽  
Enric Grau ◽  
...  
Keyword(s):  
Inflammatory Diseases ◽  
Oral Anticoagulants ◽  
Diagnostic Algorithm ◽  
Hospitalized Patients ◽  
Anticoagulation Management ◽  
Delphi Methodology ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Therapeutic Doses ◽  
Pharmacological Thromboprophylaxis

Patients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.

scholarly journals ORAL ANTICOAGULANTS IN THE TREATMENT OF VENOUS THROMBOEMBOLIC COMPLICATIONS: FOCUS ON APIXABAN

2017 ◽  
pp. 56-62 ◽  
Author(s):  
M. Yu. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
Vitamin K Antagonist ◽  
Fixed Dose ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Deep Vein

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

scholarly journals COVID-19-associated coagulopathy: review of current recommendations for diagnosis, treatment and prevention

2020 ◽  
Author(s):  
K. V. Lobastov ◽  
I. V. Schastlivtsev ◽  
O. Ya. Porembskaya ◽  
O. V. Dzenina ◽  
A. B. Bargandzhiya ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Preference ◽  
Thromboembolic Complications ◽  
Treatment And Prevention ◽  
Venous Thromboembolic ◽  
Coronavirus Infection ◽  
Discharge From Hospital ◽  
Therapeutic Doses

The coronavirus infection COVID-19 is a highly contagious disease caused by the SARS-CoV-2 virus. Specific prothrombotic changes of the hemostasis system in COVID-19 are associated with increased incidence of venous thromboembolic complications. The article is a literature review on the diagnosis, treatment and prevention of coagulopathy and venous thromboembolic complications associated with COVID-19. 11 studies evaluating the frequency of registration of venous thromboembolic complications and 11 clinical recommendations on correction of coagulopathy published before May 22, 2020 have been studied. The frequency of venous thromboembolic complications was unexpectedly high: 8-13% in the general ward and 9-18% in the intensive care unit against the background of preventive measures. Preventive doses of anticoagulants, low-molecular weight heparins or unfractionated heparin are indicated to all hospitalized patients. Prolonged prophylaxis after discharge from hospital can be recommended for those at high risk of venous thromboembolic complications and low risk of bleeding. An increase in D-dimer may be considered as an indication for instrumental detection of venous thromboembolic complications. If there is a suspicion of venous thromboembolic complications, anticoagulant therapy at therapeutic doses can be started before the diagnosis is confirmed: during inpatient treatment preference should be given to low-molecular heparin or unfractionated heparin, after discharge from hospital it is recommended to transfer to direct oral anticoagulants for a period of at least 3 months. Routine prevention of venous thromboembolic complications in ambulatory patients is not recommended.

Heparins and Venous Thromboembolism: Current Practice and Future Directions

2001 ◽  
Vol 86 (07) ◽  
pp. 488-498 ◽  
Author(s):  
Paolo Prandoni
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Outpatient Setting ◽  
Vein Thrombosis ◽  
Treatment And Prevention ◽  
Major Orthopedic Surgery ◽  
Venous Thromboembolic ◽  
Reduction Of Mortality ◽  
Deep Vein

SummaryUnfractionated heparin (UFH) in adjusted doses and low-molecularweight heparins (LMWH) in fixed doses are the chosen therapy for the initial treatment of venous thromboembolism. The use of UFH protocols ensures that virtually all patients will promptly achieve the therapeutic range for the activated partial thromboplastin time. However, proper use of UFH requires considerable expertise, can cause inconvenience and has limitations. Unmonitored therapy with subcutaneous LMWH is at least as effective and safe as adjusted-dose UFH, is associated with a considerable reduction of mortality in cancer patients, and permits the treatment of suitable patients in an outpatient setting.LMWH in high prophylactic doses is more effective than UFH and oral anticoagulants for prevention of postoperative venous thrombosis in major orthopedic surgery. Whether thromboprophylaxis should be continued for a few additional weeks after hospital discharge is controversial. LMWH and UFH are equally effective for prevention of postoperative deep-vein thrombosis in cancer patients. In a recent controlled randomized trial, enoxaparin in high prophylactic doses was an effective and safe measure of thromboprophylaxis in ordinary bedridden patients.The efficacy and safety of pentasaccharide (the smallest antithrombin binding sequence of heparin) in the treatment and prevention of venous thromboembolic disorders is currently under investigation.

scholarly journals Safety and feasibility of rivaroxaban in deferred workup of patients with suspected deep vein thrombosis

2020 ◽  
Vol 4 (11) ◽  
pp. 2468-2476
Author(s):  
Synne G. Fronas ◽  
Anders E. A. Dahm ◽  
Hilde S. Wik ◽  
Camilla T. Jørgensen ◽  
Jostein Gleditsch ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Secondary Outcome ◽  
Vein Thrombosis ◽  
Compression Ultrasound ◽  
Therapeutic Doses ◽  
Deep Vein

Abstract Guidelines suggest using empiric low-molecular-weight heparin if the diagnostic workup of deep vein thrombosis (DVT) is expected to be delayed. The role of direct oral anticoagulants for deferred compression ultrasound imaging (CUS) in patients with suspected DVT remains unexplored. The main objective of the study was to assess the safety of deferring CUS with therapeutic doses of rivaroxaban. We prospectively included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected first or recurrent lower-extremity DVT between February 2015 and November 2018. Patients were discharged with rivaroxaban 15 mg twice daily while awaiting CUS within 24 hours if D-dimer level was ≥0.5 mg/L fibrinogen-equivalent units. The primary outcome was the rate of major bleeding incidents from study inclusion until DVT was confirmed and anticoagulation therapy continued, or otherwise up to 48 hours following administration of the last tablet of rivaroxaban. The secondary outcome was the rate of progressive DVT symptoms or symptoms or signs of pulmonary embolism between hospital discharge until venous thromboembolism was diagnosed. Six hundred twenty-four of 1653 patients referred with suspected DVT were included (37.7%; 95% confidence interval [CI], 35.4-40.1). DVT was diagnosed in 119 patients (19.1%; 95% CI, 16.1-22.3). There were no major bleeding incidents, yielding an observed major bleeding rate of 0% (1-sided 95% CI <0.4). No patients experienced major complications in the interval that CUS was deferred (0%; 95% CI, 0.0-0.6). Deferring CUS for up to 24 hours in patients with suspected DVT with therapeutic doses of rivaroxaban is a safe strategy. This trial was registered at www.clinicaltrials.gov as #NCT02486445.

scholarly journals Anticoagulation Management With Coumarinic Drugs in Chilean Patients

2019 ◽  
Vol 25 ◽  
pp. 107602961983434 ◽  
Author(s):  
Elena Nieto ◽  
Marcelo Suarez ◽  
Ángela Roco ◽  
Juan Carlos Rubilar ◽  
Francisca Tamayo ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Safety Data ◽  
Thromboembolic Disease ◽  
Cardiovascular Disorders ◽  
Anticoagulant Treatment ◽  
Efficacy And Safety ◽  
Anticoagulation Management ◽  
Number Of Patients ◽  
Rhythm Disorder ◽  
Therapeutic Doses

Warfarin and acenocoumarol are used in various cardiovascular disorders to improve the prognosis of patients with thromboembolic disease. However, there is a lack of substantial efficacy and safety data on antithrombotic prophylaxis in several countries, particularly in Latin America. The aim of this study was to provide information about the efficacy of anticoagulants in Chilean patients. Data were collected from databases of the Western Metropolitan Health Service, Santiago, Chile. We identified 6280 records of patients receiving anticoagulant treatment. The three most common diagnoses were rhythm disorder (43.7%), venous thrombosis (22%), and valvular prosthesis (10.7%). The majority of patients (98.5%) received acenocoumarol while 1.5% of patients received warfarin, at weekly therapeutic doses of 13.6 mg and 30.4 mg, respectively. For total diagnoses, the median time in the therapeutic range was 50%. However, better results, 66.7%, were observed when a telemedicine strategy was used only in Santiago Province. Our findings emphasize that in Chile, where the number of patients receiving anticoagulant treatment increases every year, telemedicine, by committed teams, improves the use of oral anticoagulants and is able to increase quality indicators of anticoagulant treatment care.

Cancer associated thrombosis in patients taking direct oral anticoagulants (DOACs): Retrospective review of a single institutional series.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14080-e14080
Author(s):  
Sophia Angelov ◽  
Andrew Peter Dean
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Retrospective Review ◽  
Pulmonary Embolus ◽  
Oral Anticoagulants ◽  
First Line ◽  
Vein Thrombosis ◽  
Therapeutic Doses ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis

e14080 Background: Venous thromboembolism (VTE) is a common and often serious complication for patients with malignancy. Even though low molecular weight heparin (LMWH) is recommended as first line therapy for initial and long term anticoagulation, patient choice may demand oral anticoagulants. This retrospective review illustrates the repeated observation of recurrent thromboembolic disease in patients taking the new class of oral anticoagulant, DOAC. Methods: The pharmacy database at our institution was searched to identify oncology patients who had received a prescription for a DOAC (rivaroxaban or apixiban). Sixtyfive patients were identified and case records were then examined for evidence of venous thromboembolism. Results: Five seperate episodes of recurrent venous thromboembolism were identified in four patients in our cohort., one patient having two seperate episodes of pulmonary embolus. All were on recommended therapeutic doses of DOAC at the time of thromboembolic event. Two patients experienced proven pulmonary embolus on CT pulmonary angiography (1 twice), one lower limb deep vein thrombosis and one upper limb deep vein thrombosis. Conclusions: This retrosepctive review reinforces the clinical guidelines stated by the Cochrane review and ASCO that LMWH should always be first line for the initial and continuation treatment of a VTE. The guidelines did not focus on the suboptimal anticoagulation aspect of the newer oral anticoagulants but more on the safety issues. Research has been mainly focused on comparing LMWH with unfractionated heparin (UFH) or oral warfarin. Comparisons between DOAC versus Warfarin as an oral form of therapy have also been made. In the available published literature, there is a paucity of research comparing DOACs to LMWH. We have identified four patients out of sixtyfive treated with therapeutic doses of DOAC who developed subsequent thromboembolism. This is additional supportive evidence that newer oral anticoagulant agents may not be efficacious in malignancy driven VTE and that LMWH should remain the standard of care. Patients specifically requesting DOAC for cancer associated VTE should be made aware of this data.

scholarly journals HOW NEW APPROACHES TO THE TREATMENT OF PULMONARY EMBOLISM AFFECT THE OUTCOME OF THE DISEASE?

2017 ◽  
pp. 48-55
Author(s):  
M. Y. Gilyarov ◽  
E. V. Konstantinova
Keyword(s):  
Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Diagnostic Techniques ◽  
New Approach ◽  
Vein Thrombosis ◽  
Improved Outcomes ◽  
Venous Thromboembolic ◽  
Deep Vein ◽  
Effective Drugs

Pulmonary embolism (PE) is the key potentially reversible cause of in-hospital mortality. To help the practitioner, leading experts in different countries are developing and updating guidelines which analyze and generalize approaches to the treatment of PE. Recently, among the factors leading to positive dynamics in outcomes of patients with PE (according to the RIETE registry),the researchers have considered improvement of diagnostic techniques as well as technical improvements in tomographic scanners. Another reason for improved outcomes of treated patients with deep vein thrombosis and pulmonary embolism is optimization of anticoagulation therapy. The emergence of “new” oral anticoagulants (NOAC: rivaroxaban, dabigatran, apixaban) marked the beginning of a qualitatively new approach to the treatment of PE characterized by convenience of treatment without the need for regular monitoring of blood coagulation parameters. In addition to the emergence of new convenient and effective drugs, the approach to diagnosis and treatment of patients also changed, as reflected in the updated guidelines for the management of patients with venous thromboembolic complications (ESC 2014, ACCP 2016).

scholarly journals COVID-19-associated coagulopathy: review of current recommendations for diagnosis, treatment and prevention

2021 ◽  
pp. 36-51
Author(s):  
K. V. Lobastov ◽  
I. V. Schastlivtsev ◽  
O. Ya. Porembskaya ◽  
O. V. Dzenina ◽  
A. B. Bargandzhiya ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Preference ◽  
Thromboembolic Complications ◽  
Treatment And Prevention ◽  
Venous Thromboembolic ◽  
Coronavirus Infection ◽  
Discharge From Hospital ◽  
Therapeutic Doses

The coronavirus infection COVID-19 is a highly contagious disease caused by the SARS-CoV-2 virus. Specific prothrombotic changes of the hemostasis system in COVID-19 are associated with increased incidence of venous thromboembolic complications. The article is a literature review on the diagnosis, treatment and prevention of coagulopathy and venous thromboembolic complications associated with COVID-19. 11 studies evaluating the frequency of registration of venous thromboembolic complications and 11 clinical recommendations on correction of coagulopathy published before May 22, 2020 have been studied. The frequency of venous thromboembolic complications was unexpectedly high: 8–13% in the general ward and 9–18% in the intensive care unit against the background of preventive measures. Preventive doses of anticoagulants, low-molecular weight heparins or unfractionated heparin are indicated to all hospitalized patients. Prolonged prophylaxis after discharge from hospital can be recommended for those at high risk of venous thromboembolic complications and low risk of bleeding. An increase in D-dimer may be considered as an indication for instrumental detection of venous thromboembolic complications. If there is a suspicion of venous thromboembolic complications, anticoagulant therapy at therapeutic doses can be started before the diagnosis is confirmed: during inpatient treatment preference should be given to low-molecular heparin or unfractionated heparin, after discharge from hospital it is recommended to transfer to direct oral anticoagulants for a period of at least 3 months. Routine prevention of venous thromboembolic complications in ambulatory patients is not recommended.

Trial of Aspirin and RA 233 in Prevention of Post-operative Deep Vein Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 018-024 ◽  
Author(s):  
Edward H. Wood ◽  
Colin R.M. Prentice ◽  
D. Angus McGrouther ◽  
John Sinclair ◽  
George P. McNicol
Keyword(s):  
Deep Vein Thrombosis ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Antithrombotic Agent ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Vein Thrombosis ◽  
Effective Prophylaxis ◽  
Deep Vein ◽  
Calf Vein

SummaryAlthough the oral anticoagulants provide effective prophylaxis against postoperative deep vein thrombosis following fracture of neck of femur there is a need for an antithrombotic agent which needs less laboratory control and does not cause haemorrhagic complications. It has been suggested that drugs causing inhibition of platelet function may fulfil these requirements. A controlled trial was carried out in which aspirin, RA 233, or a combination of these drugs was compared with a placebo in the prevention of post-operative deep vein thrombosis. In thirty patients undergoing surgery for fractured neck of femur the incidence of post-operative calf vein thrombosis, as detected by 125I-fibrinogen scanning, was not significantly different between the untreated and treated groups.

Congenital Antithrombin III Deficiency in 3 Families (7 Affected Members)

1979 ◽  
Author(s):  
J. Conard ◽  
M. Samama ◽  
M. H. Horellou ◽  
B. Cazenave ◽  
P. Griguer ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Antithrombin Iii ◽  
Oral Anticoagulants ◽  
Vena Cava ◽  
Oral Contraception ◽  
Vein Thrombosis ◽  
Heparin Treatment ◽  
At Iii ◽  
Antithrombin Iii Deficiency ◽  
Deep Vein

A congenital Antithrombin III (AT III) deficiency affecting 7 members of 3 families is reported.The first throrabo-embolic accidents were observed between the age of 22 and 35 : they were spontaneous or occured after delivery or oral contraception. in one patient, a deep vein thrombosis was observed during heparin treatment. in 2 cases, recurrent pulmonary embolic episodes required vena cava ligation. No thromboembolic accident was observed during oral anticoagulation.AT III was measured by an amidolytic method and by the Mancini method on plasma and serum ; the antithrombin activity was determined on serum by the von Kaulla method. in 7 patients, a decreased AT III was found by all the methods performed. The AT III level was around 50 % in patients treated or not by oral anticoagulants One patient was studied during heparin treatment and then under oral anticoagulants : AT III levels were lower under heparin.

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