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Giancarlo Agnelli - One of the best experts on this subject based on the ideXlab platform.
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Aspirin for prevention and treatment of Venous Thromboembolism
Blood reviews, 2014Co-Authors: Cecilia Becattini, Giancarlo AgnelliAbstract:Venous and arterial thromboses have been regarded for many years as two different diseases requiring anticoagulant or antiplatelet treatment, respectively. Platelets have a role in Venous Thromboembolism through several mechanisms, including the formation of and adhesion to the neutrophil extracellular traps, as recently demonstrated. When given for antithrombotic prophylaxis in high risk medical or surgical patients, aspirin was shown to reduce the incidence of Venous Thromboembolism in clinical studies and meta-analyses. However, controversial recommendations have been released on the role of aspirin for the prevention of Venous Thromboembolism. Two randomized, double blind trials have recently shown a reduction of recurrence by about 30% with aspirin compared to placebo in patients who had completed treatment with vitamin K antagonists for a first episode of unprovoked Venous Thromboembolism. The clinical value of this risk reduction in comparison to that obtained with warfarin and the new oral anticoagulant agents, should take into account the low risk for bleeding and costs associated with aspirin. Given its safety, worldwide availability and low cost, aspirin can be considered a valid alternative to oral anticoagulants for the extended treatment of Venous Thromboembolism after a first unprovoked event.
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Apixaban for Extended Treatment of Venous Thromboembolism.
New England Journal of Medicine, 2012Co-Authors: Giancarlo Agnelli, Harry R. Büller, Gary E. Raskob, Alexander Cohen, Madelyn Curto, Alexander S Gallus, Margot Johnson, Anthony Porcari, Jeffrey I Weitz, Dominique MottierAbstract:Background Apixaban, an oral factor Xa inhibitor that can be administered in a simple, fixed-dose regimen, may be an option for the extended treatment of Venous Thromboembolism. Methods In this randomized, double-blind study, we compared two doses of apixaban (2.5 mg and 5 mg, twice daily) with placebo in patients with Venous Thromboembolism who had completed 6 to 12 months of anticoagulation therapy and for whom there was clinical equipoise regarding the continuation or cessation of anticoagulation therapy. The study drugs were administered for 12 months. Results A total of 2486 patients underwent randomization, of whom 2482 were included in the intention-to-treat analyses. Symptomatic recurrent Venous Thromboembolism or death from Venous Thromboembolism occurred in 73 of the 829 patients (8.8%) who were receiving placebo, as compared with 14 of the 840 patients (1.7%) who were receiving 2.5 mg of apixaban (a difference of 7.2 percentage points; 95% confidence interval [CI], 5.0 to 9.3) and 14 of the 813 patients (1.7%) who were receiving 5 mg of apixaban (a difference of 7.0 percentage points; 95% CI, 4.9 to 9.1) (P
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Prevention of Venous Thromboembolism.
Thrombosis research, 2000Co-Authors: Giancarlo Agnelli, Francesco SonagliaAbstract:Venous Thromboembolism is the most common cause of preventable death among hospitalised patients. Systematic prophylaxis with antithrombotic agents in patients at risk for Venous Thromboembolism is the most effective approach to reduce morbidity and mortality. Despite this evidence, antithrombotic prophylaxis is still underused, due to the underestimation of incidence of Venous Thromboembolism and to the unjustified fear of bleeding complications. Both the characteristics of the individual patient and the clinical setting contribute to the definition of the risk for Venous Thromboembolism. Patient-related risk factors include clinical and molecular abnormalities. The grade of risk for Venous Thromboembolism is defined better by the clinical setting than by the patient characteristics. Prophylactic studies have been extensively carried out in surgical patients and, only more recently, in medical patients. Prophylactic methods include pharmacological agents, such as heparin, low molecular weight heparins, warfarin, and hirudin, as well as mechanical methods such as compression stockings and intermittent pneumatic compression.
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Prevention of Venous Thromboembolism After Neurosurgery
Thrombosis and Haemostasis, 1999Co-Authors: Giancarlo AgnelliAbstract:IntroductionThe optimal strategy for the prevention of Venous Thromboembolism in patients undergoing neurosurgery has been a matter of debate for many years,1 and it is currently under review because of the results of recent clinical trials. This issue is, indeed, of particular clinical interest because of the neurosurgeons’ fear of bleeding complications, potentially associated with the use of anticoagulants, and the high incidence of Venous Thromboembolism. Preventing Venous Thromboembolism is of crucial importance in neurosurgery patients for reasons that go beyond its high incidence. The management of patients who develop Venous Thromboembolism immediately after neurosurgery is rather complicated, due to the risks connected with the administration of therapeutic doses of heparin and warfarin. In addition, the insertion of a vena caval filter, which is frequently required, is rather expensive and not without risk. Thus, in neurosurgery, even more than in other clinical settings, the optimal strategy for the management of Venous Thromboembolism is its prevention.The purpose of this paper is to review the epidemiology of Venous Thromboembolism in neurosurgery, its biological risk factors, and the results of clinical trials that have studied the prevention of Venous Thromboembolism in this clinical setting.
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Prevention of Venous Thromboembolism in high risk patients
Haematologica, 1997Co-Authors: Giancarlo Agnelli, Francesco SonagliaAbstract:BACKGROUND AND OBJECTIVE: Venous Thromboembolism includes two closely related clinical manifestations: deep vein thrombosis (DVT), more commonly of the lower limbs, and pulmonary embolism. Pulmonary embolism is the most common cause of preventable death in hospitalized patients. The definition of the risk factors for Venous Thromboembolism should allow to adopt the most suitable prophylactic regimen. Determinants for the risk of Venous Thromboembolism are patient risk factors, both clinical and molecular, and the clinical setting. In this article the prophylactic regimens most widely employed in the prevention of Venous Thromboembolism in high-risk clinical settings with be reviewed. Then, the available guidelines for the management of thrombophilic patients will be given. INFORMATION SOURCES: The authors have been working in this field contributing original papers. In addition, the material examined in this review article includes papers published in the journals covered by the Science Citation Index and Medline. STATE OF ART AND PERSPECTIVES: Pharmacological prophylaxis is an effective approach for reducing morbidity and mortality from Venous Thromboembolism. Nevertheless, prophylaxis for Venous Thromboembolism is under employed because the incidence of Venous Thromboembolism is underestimated and there is fear of bleeding side effects. Adopting the proper prophylactic strategy for Venous Thromboembolism requires defining the patient risk factor. Determinants for the risk of Venous Thromboembolism are patient risk factors, both clinical and molecular, and the clinical setting. The risk connected with the clinical setting is the only risk defined by properly performed epidemiological studies. High-risk clinical settings are major orthopedic surgery, elective neurosurgery, spinal cord injury, cancer surgery and multiple trauma. The most effective anticoagulant regimens in the prevention of Venous Thromboembolism in high-risk patients are adjusted-dose unfractionated heparin, low molecular weight heparins (LMWHs) and oral anticoagulants. LMWHs are as effective and safe as the other two agents, but they do not require laboratory monitoring. On the other hand, LMWHs are more expensive than unfractionated heparin and warfarin. The use of effective agents still leaves the patients with a high prevalence of Venous Thromboembolism. Hence the search for more effective agents such as selective thrombin inhibitors like hirudin and its analogues. In patients undergoing elective hip surgery, hirudin has been recently shown to be more effective than low-dose unfractionated heparin and the LMWH enoxaparin.
John A. Heit - One of the best experts on this subject based on the ideXlab platform.
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The Epidemiology of Venous Thromboembolism in the Community
Arteriosclerosis thrombosis and vascular biology, 2008Co-Authors: John A. HeitAbstract:Venous Thromboembolism is a major health problem. The average annual incidence of Venous Thromboembolism among Whites is 108 per 100 000 person-years,1,2 with about 250 000 incident cases occurring annually among US whites. The incidence appears to be similar or higher among Blacks and lower among Asian- and Native-Americans.3,4 Adjusting for the different age and sex distribution of African-Americans, the Venous Thromboembolism incidence is about 78 per 100 000, suggesting that about 27 000 incident Venous Thromboembolism cases occur annually among US Blacks. Recent modeling suggests that more than 900 000 incident or recurrent, fatal and nonfatal VTE events occur in the US annually.5 The incidence of Venous Thromboembolism has not changed significantly over the last 25 years.2 Venous Thromboembolism is predominantly a disease of older age.1,2,6 Incidence rates increase exponentially with age for both men and women and for both deep vein thrombosis and pulmonary embolism.1,2,6 The overall age-adjusted incidence rate is higher for men (114 per 100 000) then women (105 per 100 000; male:female sex ratio is 1.2:1).1,2 Incidence rates are somewhat higher in women during the childbearing years, whereas incidence rates after age 45 years are generally higher in men. Pulmonary embolism accounts for an increasing proportion of Venous Thromboembolism with increasing age for both genders.1 Observed survival after Venous Thromboembolism is significantly worse than expected survival for age and gender, and survival after pulmonary embolism is much worse than after deep vein thrombosis alone.7,8 The risk of early death among patients with symptomatic pulmonary embolism is 18-fold higher compared to patients with deep vein thrombosis alone.7 Pulmonary embolism is an independent predictor of reduced survival for up to 3 months after onset. For almost one-quarter of pulmonary …
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Risk factors for Venous Thromboembolism.
Clinics in chest medicine, 2003Co-Authors: John A. HeitAbstract:Venous Thromboembolism is a common and potentially lethal disease. Patients who have pulmonary embolism are at especially high risk for death. Death owing to pulmonary embolism is independent of other comorbid conditions (e.g., cancer, chronic heart disease, or lung disease). Sudden death is often the first clinical manifestation. Only a reduction in the incidence of Venous Thromboembolism can reduce sudden death owing to pulmonary embolism and Venous stasis syndrome owing to deep vein thrombosis. The incidence of Venous Thromboembolism has been relatively constant since about 1980. Improvement in the incidence of Venous Thromboembolism will require better recognition of persons at risk, improved estimates of the magnitude of risk, the avoidance of risk exposure when possible, more widespread use of safe and effective prophylaxis when risk is unavoidable, and targeting of prophylaxis to those persons who will benefit most. Recognition of Venous Thromboembolism as a multifactorial disease with genetic and genetic-environmental interaction has provided significant insights into its epidemiology and offers the possibility of improved identification of persons at risk for incident and recurrent Venous Thromboembolism.
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Prevention of Venous Thromboembolism.
Clinics in geriatric medicine, 2001Co-Authors: John A. HeitAbstract:Venous Thromboembolism is a common and potentially lethal disease with severe long-term complications. Prevention of Venous Thromboembolism is key to improving survival and reducing complications. Venous Thromboembolism is predominantly a disease of older age. In addition to increasing age, male gender, Caucasian or African-American ancestry, hospitalization, surgery, trauma, malignant neoplasm, neurologic disease with extremity paresis, prior superficial vein thrombosis, and hormone therapy further identify a population at increased risk for Venous Thromboembolism. All such patients should receive appropriate prophylaxis as outlined in this article.
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The epidemiology of Venous Thromboembolism in the community.
Thrombosis and haemostasis, 2001Co-Authors: John A. Heit, Marc D. Silverstein, David N. Mohr, Tanya M. Petterson, Christine M. Lohse, W. Michael O'fallon, L. Joseph MeltonAbstract:The incidence of Venous Thromboembolism exceeds 1 per 1000; over 200,000 new cases occur in the United States annually. Of these, 30% die within 30 days; one-fifth suffer sudden death due to pulmonary embolism. Despite improved prophylaxis, the incidence of Venous Thromboembolism has been constant since 1980. Independent risk factors for Venous Thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, central Venous catheter/ transVenous pacemaker, prior superficial vein thrombosis, and varicose veins; among women, risk factors include pregnancy, oral contraceptives, and hormone replacement therapy. About 30% of surviving cases develop recurrent Venous Thromboembolism within ten years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm, and extremity paresis. About 28% of cases develop Venous stasis syndrome within 20 years. To reduce Venous Thromboembolism incidence, improve survival, and prevent recurrence and complications, patients with these characteristics should receive appropriate prophylaxis.
Alexander T. Cohen - One of the best experts on this subject based on the ideXlab platform.
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Magnitude of Venous Thromboembolism Risk in US Hospitals: Impact of Evolving National Guidelines for Prevention of Venous Thromboembolism.
The American journal of medicine, 2019Co-Authors: Wei Huang, Alexander T. Cohen, Anne-céline Martin, Frederick A. AndersonAbstract:Abstract Background The annual number of US hospital discharges at risk for Venous Thromboembolism and the impact of evolving American College of Chest Physicians (ACCP) consensus guidelines for prevention of Venous Thromboembolism are unknown. Methods Three risk-assessment algorithms based on 2004, 2008, and 2012 ACCP guidelines for prevention of Venous Thromboembolism were applied to the 2014 US National Inpatient Sample to derive estimates of the annual number of US inpatients at risk for Venous Thromboembolism. Results Of 35.4 million discharges from US acute-care hospitals in 2014, 25.3 million (71%) met study inclusion criteria of age ≥18 years and length of stay (LOS) ≥2 days. Among 7.5 million patients who underwent a procedure in an operating room, more than 4.4 million (59%) were at ACCP-defined risk for Venous Thromboembolism, irrespective of which version of the ACCP guidelines applied. With an additional 8.4/8.5/7.3 million eligible discharges meeting criteria for Venous Thromboembolism prophylaxis due to medical risk factors, the total annual numbers of inpatients at risk for Venous Thromboembolism were 12.8/12.9/11.7 million according to 2004/2008/2012 ACCP guidelines, respectively. Conclusions Over half of adult patients who had an LOS ≥2 days in US acute-care hospitals met ACCP criteria for consideration of Venous Thromboembolism prophylaxis based on risk factors associated with surgery or acute medical illness. These data provide an objective basis for estimating the potential impact of Venous Thromboembolism prevention on patient care, together with associated costs, risks, and benefits.
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Prophylaxis of Venous Thromboembolism in medical patients.
Current opinion in pulmonary medicine, 2001Co-Authors: Alexander T. Cohen, Raza AlikhanAbstract:Prophylaxis of Venous Thromboembolism in medical patients is an area where the potential benefits to patients are great. Venous Thromboembolism is at least as common among medical as it is among surgical patients. Despite the widespread use of thromboprophylaxis in surgical patients, fatal pulmonary embolism is one of the most common causes of preventable death in the hospital. This may result from underuse of thromboprophylaxis in medical patients. The incidence of Venous Thromboembolism varies, but a history of previous Venous Thromboembolism, age 40 years and older, immobility, and specific illnesses such as stroke, myocardial infarction, heart failure, and cancer put patients at particular risk. Most early studies assessed the use of anticoagulants such as unfractionated heparin, low-molecular-weight heparin, and warfarin at reducing the incidence of Venous Thromboembolism in surgical patients. More recent studies and those currently being carried out are assessing the role of thromboprophylaxis in general medical patients and those with specific medical illnesses. As the evidence accumulates and guidelines are strengthened physicians will be able to tailor the use of thromboprophylaxis to the individual patient's needs.
Chantal Menard - One of the best experts on this subject based on the ideXlab platform.
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Oral Contraceptives and the Risk of Venous Thromboembolism: An Update
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2010Co-Authors: Robert L. Reid, Nicholas Leyland, Wendy Wolfman, Catherine Allaire, Alaa Awadalla, Carolyn Best, Sheila Dunn, Madeleine Lemyre, Violaine Marcoux, Chantal MenardAbstract:Abstract Objective To provide current and emerging evidence on oral contraceptives and the risk of Venous Thromboembolism. Evidence Articles published in English from 2005 were retrieved through searches of PubMed and Medline, using the following terms: Venous Thromboembolism, VTE, contraception, oral contraceptives, hormonal contraception. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table). Summary Statements 1.Modern oral contraceptives offer highly effective contraception and a range of non-contraceptive benefits. (I) 2.Venous Thromboembolism, although rare, remains one of the serious adverse consequences of hormonal contraception. Best evidence indicates that Venous Thromboembolism rates in non-users of reproductive age approximate 4–5/10 000 women per year; rates in oral contraceptive users are in the range of 9–10/10 000 women per year. For comparison, Venous Thromboembolism rates in pregnancy approach 29/10 000 overall and may reach 300–400/10 000 in the immediate postpartum period. (II-1) 3.Research demonstrates that oral contraceptives with ≤ 35 μg of ethinyl estradiol carry a lower risk of Venous Thromboembolism than oral contraceptives with 50 μg. (II-2) Although preliminary data suggest a possible further reduction in Venous Thromboembolism with oral contraceptives with 4.Recent contradictory evidence and the ensuing media coverage of the Venous Thromboembolism risk attributed to the progestin component of certain newer oral contraceptive products have led to fear and confusion about the safety of oral contraceptives in general and drospirenone-containing oral contraceptives in particular. "Pill scares" of this nature have occurred in the past, with panic stopping of the pill, increased rates of unplanned pregnancy, and no subsequent decrease in Venous Thromboembolism rates. (II-3) 5.Two high quality research studies that addressed the Venous Thromboembolism risk associated with various oral contraceptives found comparable Venous Thromboembolism rates with drospirenone-containing oral contraceptives and other approved products. (II-1) 6.Two reports suggesting an increased risk of Venous Thromboembolism with drospirenone-containing oral contraceptives have significant methodological flaws that render their conclusions suspect. It seems likely that residual confounding could have distorted both the results and the conclusions of these reports. (II-3)
Raza Alikhan - One of the best experts on this subject based on the ideXlab platform.
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Prophylaxis of Venous Thromboembolism in medical patients.
Current opinion in pulmonary medicine, 2001Co-Authors: Alexander T. Cohen, Raza AlikhanAbstract:Prophylaxis of Venous Thromboembolism in medical patients is an area where the potential benefits to patients are great. Venous Thromboembolism is at least as common among medical as it is among surgical patients. Despite the widespread use of thromboprophylaxis in surgical patients, fatal pulmonary embolism is one of the most common causes of preventable death in the hospital. This may result from underuse of thromboprophylaxis in medical patients. The incidence of Venous Thromboembolism varies, but a history of previous Venous Thromboembolism, age 40 years and older, immobility, and specific illnesses such as stroke, myocardial infarction, heart failure, and cancer put patients at particular risk. Most early studies assessed the use of anticoagulants such as unfractionated heparin, low-molecular-weight heparin, and warfarin at reducing the incidence of Venous Thromboembolism in surgical patients. More recent studies and those currently being carried out are assessing the role of thromboprophylaxis in general medical patients and those with specific medical illnesses. As the evidence accumulates and guidelines are strengthened physicians will be able to tailor the use of thromboprophylaxis to the individual patient's needs.
