Effectiveness and safety of #rivaroxaban and warfarin in patients with unprovoked venous #thromboembolism: a propensity-matched nationwide cohort study
http://thelancet.com/journals/lanhae/article/PIIS2352-3026(17)30054-6/fulltext
The rate of recurrent VTE at 6 months' follow-up was 9·9 incidents per 100 person-years with rivaroxaban versus 13·1 incidents per 100 person-years with warfarin, yielding a hazard ratio (HR) of 0·74 (95% CI 0·56–0·96). The rate of major bleeding was 2·4 per 100 person-years at 6 months in rivaroxaban users versus 2·0 in warfarin users (HR 1·19, 95% CI 0·66–2·13).
Interpretation
In this clinical practice setting, rivaroxaban in patients with unprovoked VTE was associated with reduced risk of recurrent VTE compared with standard treatment, without compromising safety.
http://thelancet.com/journals/lanhae/article/PIIS2352-3026(17)30054-6/fulltext
The rate of recurrent VTE at 6 months' follow-up was 9·9 incidents per 100 person-years with rivaroxaban versus 13·1 incidents per 100 person-years with warfarin, yielding a hazard ratio (HR) of 0·74 (95% CI 0·56–0·96). The rate of major bleeding was 2·4 per 100 person-years at 6 months in rivaroxaban users versus 2·0 in warfarin users (HR 1·19, 95% CI 0·66–2·13).
Interpretation
In this clinical practice setting, rivaroxaban in patients with unprovoked VTE was associated with reduced risk of recurrent VTE compared with standard treatment, without compromising safety.
#Rivaroxaban or #Aspirin for Extended Treatment of Venous #Thromboembolism
http://www.nejm.org/doi/full/10.1056/NEJMoa1700518#article
Background
Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin.
Conclusions
Among patients with venous thromboembolism in equipoise for continued anticoagulation, the risk of a recurrent event was significantly lower with rivaroxaban at either a treatment dose (20 mg) or a prophylactic dose (10 mg) than with aspirin, without a significant increase in bleeding rates.
http://www.nejm.org/doi/full/10.1056/NEJMoa1700518#article
Background
Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin.
Conclusions
Among patients with venous thromboembolism in equipoise for continued anticoagulation, the risk of a recurrent event was significantly lower with rivaroxaban at either a treatment dose (20 mg) or a prophylactic dose (10 mg) than with aspirin, without a significant increase in bleeding rates.
New England Journal of Medicine
Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism | NEJM
Original Article from The New England Journal of Medicine — Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism
Screening for Occult #Cancer in Patients With Unprovoked Venous #Thromboembolism: A Systematic Review and Meta-analysis of Individual Patient Data
http://annals.org/aim/article/2649299/screening-occult-cancer-patients-unprovoked-venous-thromboembolism-systematic-review-meta
10 eligible studies were identified. Individual data were obtained for all 2316 patients. Mean age was 60 years; 58% of patients received extensive screening. The 12-month period prevalence of cancer after VTE diagnosis was 5.2% (95% CI, 4.1% to 6.5%). The point prevalence of cancer was higher in patients who had extensive screening than in those who had more limited screening initially (odds ratio OR, 2.0 CI, 1.2 to 3.4) but not at 12 months (OR, 1.4 CI, 0.89 to 2.1). Cancer prevalence increased linearly with age and was 7-fold higher in patients aged 50 years or older than in younger patients
Occult cancer is detected in 1 in 20 patients within a year of receiving a diagnosis of unprovoked VTE. Older age is associated with a higher cancer prevalence. Although an extensive screening strategy initially may detect more cancer cases than limited screening, whether this translates into improved patient outcomes remains unclear
http://annals.org/aim/article/2649299/screening-occult-cancer-patients-unprovoked-venous-thromboembolism-systematic-review-meta
10 eligible studies were identified. Individual data were obtained for all 2316 patients. Mean age was 60 years; 58% of patients received extensive screening. The 12-month period prevalence of cancer after VTE diagnosis was 5.2% (95% CI, 4.1% to 6.5%). The point prevalence of cancer was higher in patients who had extensive screening than in those who had more limited screening initially (odds ratio OR, 2.0 CI, 1.2 to 3.4) but not at 12 months (OR, 1.4 CI, 0.89 to 2.1). Cancer prevalence increased linearly with age and was 7-fold higher in patients aged 50 years or older than in younger patients
Occult cancer is detected in 1 in 20 patients within a year of receiving a diagnosis of unprovoked VTE. Older age is associated with a higher cancer prevalence. Although an extensive screening strategy initially may detect more cancer cases than limited screening, whether this translates into improved patient outcomes remains unclear
annals.org
Occult Cancer Screening in Unprovoked Venous Thromboembolism | Annals of Internal Medicine | American College of Physicians
Background: Screening for cancer in patients with unprovoked venous thromboembolism (VTE) often is considered, but clinicians need precise data on cancer prevalence, risk factors, and the effect of different types of screening strategies. Purpose: To…
Comparative safety of direct oral #anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study
http://www.bmj.com/content/359/bmj.j4323
To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous #thromboembolism Of the 59 525 participants, 1967 (3.3%) had a major bleed and 1029 (1.7%) died over a mean follow-up of 85.2 days. The risk of major bleeding was similar for DOAC compared with warfarin use (pooled hazard ratio 0.92, 95% confidence interval 0.82 to 1.03), with the overall direction of the association favouring DOAC use. No difference was found in the risk of death (pooled hazard ratio 0.99, 0.84 to 1.16) for DOACs compared with warfarin use. There was no evidence of heterogeneity across centres, between patients with and without chronic kidney disease, across age groups, or between male and female patients.
Conclusions In this analysis of adults with incident venous thromboembolism, treatment with DOACs, compared with warfarin, was not associated with an increased risk of major bleeding or all cause mortality in the first 90 days of treatment.
http://www.bmj.com/content/359/bmj.j4323
To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous #thromboembolism Of the 59 525 participants, 1967 (3.3%) had a major bleed and 1029 (1.7%) died over a mean follow-up of 85.2 days. The risk of major bleeding was similar for DOAC compared with warfarin use (pooled hazard ratio 0.92, 95% confidence interval 0.82 to 1.03), with the overall direction of the association favouring DOAC use. No difference was found in the risk of death (pooled hazard ratio 0.99, 0.84 to 1.16) for DOACs compared with warfarin use. There was no evidence of heterogeneity across centres, between patients with and without chronic kidney disease, across age groups, or between male and female patients.
Conclusions In this analysis of adults with incident venous thromboembolism, treatment with DOACs, compared with warfarin, was not associated with an increased risk of major bleeding or all cause mortality in the first 90 days of treatment.
The BMJ
Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational…
Objective To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous thromboembolism.
Design Retrospective matched cohort study conducted between 1 January 2009 and 31 March 2016.
Setting Community…
Design Retrospective matched cohort study conducted between 1 January 2009 and 31 March 2016.
Setting Community…
#Edoxaban for the Treatment of #Cancer-Associated Venous #Thromboembolism
http://www.nejm.org/doi/full/10.1056/NEJMoa1711948
Of the 1050 patients who underwent randomization, 1046 were included in the modified intention-to-treat analysis. A primary-outcome event occurred in 67 of the 522 patients (12.8%) in the edoxaban group as compared with 71 of the 524 patients (13.5%) in the dalteparin group (hazard ratio, 0.97; 95% confidence interval [CI], 0.70 to 1.36; P=0.006 for noninferiority; P=0.87 for superiority). Recurrent venous thromboembolism occurred in 41 patients (7.9%) in the edoxaban group and in 59 patients (11.3%) in the dalteparin group (difference in risk, −3.4 percentage points; 95% CI, −7.0 to 0.2). Major bleeding occurred in 36 patients (6.9%) in the edoxaban group and in 21 patients (4.0%) in the dalteparin group (difference in risk, 2.9 percentage points; 95% CI, 0.1 to 5.6).
CONCLUSIONS
Oral edoxaban was noninferior to subcutaneous dalteparin with respect to the composite outcome of recurrent venous thromboembolism or major bleeding. The rate of recurrent venous thromboembolism was lower but the rate of major bleeding was higher with edoxaban than with dalteparin.
http://www.nejm.org/doi/full/10.1056/NEJMoa1711948
Of the 1050 patients who underwent randomization, 1046 were included in the modified intention-to-treat analysis. A primary-outcome event occurred in 67 of the 522 patients (12.8%) in the edoxaban group as compared with 71 of the 524 patients (13.5%) in the dalteparin group (hazard ratio, 0.97; 95% confidence interval [CI], 0.70 to 1.36; P=0.006 for noninferiority; P=0.87 for superiority). Recurrent venous thromboembolism occurred in 41 patients (7.9%) in the edoxaban group and in 59 patients (11.3%) in the dalteparin group (difference in risk, −3.4 percentage points; 95% CI, −7.0 to 0.2). Major bleeding occurred in 36 patients (6.9%) in the edoxaban group and in 21 patients (4.0%) in the dalteparin group (difference in risk, 2.9 percentage points; 95% CI, 0.1 to 5.6).
CONCLUSIONS
Oral edoxaban was noninferior to subcutaneous dalteparin with respect to the composite outcome of recurrent venous thromboembolism or major bleeding. The rate of recurrent venous thromboembolism was lower but the rate of major bleeding was higher with edoxaban than with dalteparin.
The New England Journal of Medicine
Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism | NEJM
Low-molecular-weight heparin is the standard treatment for cancer-associated venous
thromboembolism. The role of treatment with direct oral anticoagulant agents is unclear.
In this open-label, noni...
thromboembolism. The role of treatment with direct oral anticoagulant agents is unclear.
In this open-label, noni...
Association of #Varicose Veins With Incident Venous #Thromboembolism and Peripheral #Artery Disease
https://jamanetwork.com/journals/jama/article-abstract/2673551?redirect=true
The median follow-up duration was 7.5 years for DVT, 7.8 years for PE, and 7.3 years for PAD for patients with varicose veins, and for the control group, follow-up duration was 7.6 years for DVT, 7.7 years for PE, and 7.4 years for PAD. The varicose veins group had higher incidence rates than the control group for DVT (6.55 vs 1.23 per 1000 person-years 10 360 vs 1980 cases; absolute risk difference ARD, 5.32 95% CI, 5.18-5.46), for PE (0.48 for the varicose veins group vs 0.28 for the control group per 1000 person-years 793 vs 451 cases; ARD, 0.20 95% CI, 0.16-0.24), and for PAD (10.73 for the varicose veins group vs 6.22 for the control group per 1000 person-years 16 615 vs 9709 cases; ARD, 4.51 95% CI, 4.31-4.71). The hazard ratios for the varicose veins group compared with the control group were 5.30 (95% CI, 5.05-5.56) for DVT, 1.73 (95% CI, 1.54-1.94) for PE, and 1.72 (95% CI, 1.68-1.77) for PAD.
Conclusions and Relevance Among adults diagnosed with varicose veins, there was a significantly increased risk of incident DVT; the findings for PE and PAD are less clear due to the potential for confounding. Whether the association between varicose veins and DVT is causal or represents a common set of risk factors requires further research
https://jamanetwork.com/journals/jama/article-abstract/2673551?redirect=true
The median follow-up duration was 7.5 years for DVT, 7.8 years for PE, and 7.3 years for PAD for patients with varicose veins, and for the control group, follow-up duration was 7.6 years for DVT, 7.7 years for PE, and 7.4 years for PAD. The varicose veins group had higher incidence rates than the control group for DVT (6.55 vs 1.23 per 1000 person-years 10 360 vs 1980 cases; absolute risk difference ARD, 5.32 95% CI, 5.18-5.46), for PE (0.48 for the varicose veins group vs 0.28 for the control group per 1000 person-years 793 vs 451 cases; ARD, 0.20 95% CI, 0.16-0.24), and for PAD (10.73 for the varicose veins group vs 6.22 for the control group per 1000 person-years 16 615 vs 9709 cases; ARD, 4.51 95% CI, 4.31-4.71). The hazard ratios for the varicose veins group compared with the control group were 5.30 (95% CI, 5.05-5.56) for DVT, 1.73 (95% CI, 1.54-1.94) for PE, and 1.72 (95% CI, 1.68-1.77) for PAD.
Conclusions and Relevance Among adults diagnosed with varicose veins, there was a significantly increased risk of incident DVT; the findings for PE and PAD are less clear due to the potential for confounding. Whether the association between varicose veins and DVT is causal or represents a common set of risk factors requires further research
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A new risk assessment model for the stratification of the #thromboembolism risk in medical patients: the #TEVERE score
https://www.ncbi.nlm.nih.gov/m/pubmed/29856190/?i=1&from=l%27angiocola
...The TEV risk factors with more statistical significance (p<0.01) are: previous VTE, active cancer, known thrombophilic condition, immobilization, chronic venous insufficiency, hyperhomocysteinemia, central venous catheter, recent hospitalization. Obesity, recent surgery, family history of VTE, hormone therapy and treatment with drugs that stimulate hematopoiesis are resulted at intermediate statistical significance (p<0.05 but >0.01). A multiple logistic regression was used with robust standard errors and forward selection of the candidate variables using the Bayesian information criterion. A new score is developed, the "TEVere Score", which shows an higher specificity and sensitivity (respectively 43.3 and 87.5, with accuracy 72.1) compared with the Padua, the Kuscer and the Chopard score. TEVere score also exhibits a greater predictive validity for thromboembolism risk (AUROC 0.7266; 95% CI, 0.71 to 0.73) than the Kuscer score..
CONCLUSIONS: The TEVere score has proven to exhibit a higher accuracy than the other scores commonly used in clinical practice to stratify the thromboembolism risk.
A new risk assessment model for the stratification of the #thromboembolism risk in medical patients: the #TEVERE score
https://www.ncbi.nlm.nih.gov/m/pubmed/29856190/?i=1&from=l%27angiocola
...The TEV risk factors with more statistical significance (p<0.01) are: previous VTE, active cancer, known thrombophilic condition, immobilization, chronic venous insufficiency, hyperhomocysteinemia, central venous catheter, recent hospitalization. Obesity, recent surgery, family history of VTE, hormone therapy and treatment with drugs that stimulate hematopoiesis are resulted at intermediate statistical significance (p<0.05 but >0.01). A multiple logistic regression was used with robust standard errors and forward selection of the candidate variables using the Bayesian information criterion. A new score is developed, the "TEVere Score", which shows an higher specificity and sensitivity (respectively 43.3 and 87.5, with accuracy 72.1) compared with the Padua, the Kuscer and the Chopard score. TEVere score also exhibits a greater predictive validity for thromboembolism risk (AUROC 0.7266; 95% CI, 0.71 to 0.73) than the Kuscer score..
CONCLUSIONS: The TEVere score has proven to exhibit a higher accuracy than the other scores commonly used in clinical practice to stratify the thromboembolism risk.
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Association of Perioperative Red Blood Cell #Transfusions With Venous #Thromboembolism in a North American Registry
https://jamanetwork.com/journals/jamasurgery/fullarticle/2683886
..A significant dose-response effect was observed with increased odds of VTE as the number of intraoperative and/or postoperative RBC transfusion events increased (aOR, 2.1 95% CI, 2.0-2.3 for 1 event; 3.1 95% CI, 1.7-5.7 for 2 events; and 4.5 95% CI, 1.0-19.4 for ≥3 events vs no intraoperative or postoperative RBC transfusion; P < .001 for trend). In subgroup analyses, the association between any perioperative RBC transfusion and postoperative VTE remained statistically significant across all surgical subspecialties analyzed. The association between any perioperative RBC transfusion and the development of postoperative VTE also remained robust after 1:1 propensity score matching (47 142 matched pairs; matched OR, 1.9; 95% CI, 1.8-2.1).
Conclusions and Relevance The results of this study suggest that perioperative RBC transfusions may be significantly associated with the development of new or progressive postoperative VTE, independent of several putative confounders. These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices.
Association of Perioperative Red Blood Cell #Transfusions With Venous #Thromboembolism in a North American Registry
https://jamanetwork.com/journals/jamasurgery/fullarticle/2683886
..A significant dose-response effect was observed with increased odds of VTE as the number of intraoperative and/or postoperative RBC transfusion events increased (aOR, 2.1 95% CI, 2.0-2.3 for 1 event; 3.1 95% CI, 1.7-5.7 for 2 events; and 4.5 95% CI, 1.0-19.4 for ≥3 events vs no intraoperative or postoperative RBC transfusion; P < .001 for trend). In subgroup analyses, the association between any perioperative RBC transfusion and postoperative VTE remained statistically significant across all surgical subspecialties analyzed. The association between any perioperative RBC transfusion and the development of postoperative VTE also remained robust after 1:1 propensity score matching (47 142 matched pairs; matched OR, 1.9; 95% CI, 1.8-2.1).
Conclusions and Relevance The results of this study suggest that perioperative RBC transfusions may be significantly associated with the development of new or progressive postoperative VTE, independent of several putative confounders. These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices.
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Glycoprotein IIb/IIIa Receptor Imaging with 18F-GP1 #PET for Acute Venous #Thromboembolism: An Open-Label, Nonrandomized, Phase 1 Study
http://m.jnm.snmjournals.org/content/60/2/244
18F-GP1 PET/CT was well tolerated, without any drug-related adverse events, and showed high initial uptake in the spleen, kidneys, and blood pool, followed by rapid clearance. The overall image quality was excellent and allowed interpretation in all patients. 18F-GP1 PET/CT identified thromboembolic foci in all 20 patients with either DVT or PE. Vessel-level analysis revealed that 18F-GP1 PET/CT detected 89% (68/76) of vessels with DVT and 60% (146/245) with PE. Importantly, 18F-GP1 PET/CT showed increased uptake in 32 vessels that were not detected by conventional imaging, of which 25 were located in distal veins of the lower extremity in 12 patients. A positive correlation was found between 18F-GP1 uptake and P-selectin–positive circulating platelets (r = 0.656, P = 0.002).
Conclusion: 18F-GP1 is a promising PET tracer for imaging acute venous thromboembolism in patients. 18F-GP1 PET/CT may identify thrombi in distal veins of the leg, where conventional imaging has limitations.
Glycoprotein IIb/IIIa Receptor Imaging with 18F-GP1 #PET for Acute Venous #Thromboembolism: An Open-Label, Nonrandomized, Phase 1 Study
http://m.jnm.snmjournals.org/content/60/2/244
18F-GP1 PET/CT was well tolerated, without any drug-related adverse events, and showed high initial uptake in the spleen, kidneys, and blood pool, followed by rapid clearance. The overall image quality was excellent and allowed interpretation in all patients. 18F-GP1 PET/CT identified thromboembolic foci in all 20 patients with either DVT or PE. Vessel-level analysis revealed that 18F-GP1 PET/CT detected 89% (68/76) of vessels with DVT and 60% (146/245) with PE. Importantly, 18F-GP1 PET/CT showed increased uptake in 32 vessels that were not detected by conventional imaging, of which 25 were located in distal veins of the lower extremity in 12 patients. A positive correlation was found between 18F-GP1 uptake and P-selectin–positive circulating platelets (r = 0.656, P = 0.002).
Conclusion: 18F-GP1 is a promising PET tracer for imaging acute venous thromboembolism in patients. 18F-GP1 PET/CT may identify thrombi in distal veins of the leg, where conventional imaging has limitations.
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Risk and Risk Factors Associated With Recurrent Venous #Thromboembolism Following #Surgery in Patients With History of Venous Thromboembolism
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733182
Of the 3741 patients, 580 (15.5%) underwent surgery and 601 (16.1%) developed a recurrent thrombotic event. The 1-month cumulative incidence of recurrent VTE for all surgery types was 2.1% (95% CI, 1.2%-3.6%), which increased to 3.3% (95% CI, 2.1%-5.1%) at 3 months and 4.6% (95% CI, 3.1%-6.6%) at 6 months. At 6 months, risk of recurrent VTE ranged from 2.3% to 9.3%, depending on surgery type. In addition to surgery type, factor V Leiden mutation (HR, 3.4; 95% CI, 1.6-7.4) and male sex (HR, 2.7; 95% CI, 1.3-5.8) were associated with increased risk of recurrent VTE.
Conclusions and Relevance Surgery was associated with an increased risk of recurrent VTE in patients with a history of VTE; risk remained high for up to 6 months after the procedure. This study suggests that high-risk individuals may be identified based on surgery type, sex, and the presence of factor V Leiden mutation.
These findings stress the need for revision of the current thromboprophylactic approach to prevent recurrence in these patients
Risk and Risk Factors Associated With Recurrent Venous #Thromboembolism Following #Surgery in Patients With History of Venous Thromboembolism
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733182
Of the 3741 patients, 580 (15.5%) underwent surgery and 601 (16.1%) developed a recurrent thrombotic event. The 1-month cumulative incidence of recurrent VTE for all surgery types was 2.1% (95% CI, 1.2%-3.6%), which increased to 3.3% (95% CI, 2.1%-5.1%) at 3 months and 4.6% (95% CI, 3.1%-6.6%) at 6 months. At 6 months, risk of recurrent VTE ranged from 2.3% to 9.3%, depending on surgery type. In addition to surgery type, factor V Leiden mutation (HR, 3.4; 95% CI, 1.6-7.4) and male sex (HR, 2.7; 95% CI, 1.3-5.8) were associated with increased risk of recurrent VTE.
Conclusions and Relevance Surgery was associated with an increased risk of recurrent VTE in patients with a history of VTE; risk remained high for up to 6 months after the procedure. This study suggests that high-risk individuals may be identified based on surgery type, sex, and the presence of factor V Leiden mutation.
These findings stress the need for revision of the current thromboprophylactic approach to prevent recurrence in these patients
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Long term risk of symptomatic recurrent venous #thromboembolism after discontinuation of #anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis
https://www.bmj.com/content/366/bmj.l4363
.. Compared to patients with isolated pulmonary embolism, the rate of recurrent VTE was higher in patients with proximal deep vein thrombosis (rate ratio 1.4, 95% confidence interval 1.1 to 1.7) and in patients with pulmonary embolism plus deep vein thrombosis (1.5, 1.1 to 1.9). In patients with distal deep vein thrombosis, the pooled rate of recurrent VTE per 100 person years was 1.9 events in the first year after anticoagulation had stopped. The case fatality rate for recurrent VTE was 4% (95% confidence interval 2% to 6%).
Conclusions In patients with a first episode of unprovoked VTE who completed at least three months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at two years, 25% at five years, and 36% at 10 years, with 4% of recurrent VTE events resulting in death. These estimates should inform clinical practice guidelines, enhance confidence in counselling patients of their prognosis, and help guide decision making about long term management of unprovoked VTE.
Long term risk of symptomatic recurrent venous #thromboembolism after discontinuation of #anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis
https://www.bmj.com/content/366/bmj.l4363
.. Compared to patients with isolated pulmonary embolism, the rate of recurrent VTE was higher in patients with proximal deep vein thrombosis (rate ratio 1.4, 95% confidence interval 1.1 to 1.7) and in patients with pulmonary embolism plus deep vein thrombosis (1.5, 1.1 to 1.9). In patients with distal deep vein thrombosis, the pooled rate of recurrent VTE per 100 person years was 1.9 events in the first year after anticoagulation had stopped. The case fatality rate for recurrent VTE was 4% (95% confidence interval 2% to 6%).
Conclusions In patients with a first episode of unprovoked VTE who completed at least three months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at two years, 25% at five years, and 36% at 10 years, with 4% of recurrent VTE events resulting in death. These estimates should inform clinical practice guidelines, enhance confidence in counselling patients of their prognosis, and help guide decision making about long term management of unprovoked VTE.
The BMJ
Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked…
Objectives To determine the rate of a first recurrent venous thromboembolism (VTE) event after discontinuation of anticoagulant treatment in patients with a first episode of unprovoked VTE, and the cumulative incidence for recurrent VTE up to 10 years.
Design…
Design…
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Venous #thromboembolism prophylaxis strategies for people undergoing elective total #knee replacement: a systematic review and network meta-analysis
https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30155-3/fulltext
Risk of bias ranged from very low to high. Rivaroxaban ranked first for prevention of deep vein thrombosis (RR 0·12 [95% CrI 0·06–0·22]). Low molecular weight heparin (LMWH; standard prophylactic dose, 28–35 days) ranked first in the pulmonary embolism network (RR 0·02 [95% CrI 0·00–3·86]) and LMWH (low prophylactic dose, 10–14 days) ranked first in the major bleeding network (odds ratio 0·08 [95% CrI 0·00–1·76]), but the results for pulmonary embolism and major bleeding are highly uncertain.
Interpretation
Single prophylaxis strategies are more effective in prevention of deep vein thrombosis in the elective total knee replacement population than combination strategies, with rivaroxaban being the most effective. The results of the pulmonary embolism and major bleeding meta-analyses are uncertain and no clear conclusion can be made other than what is biologically plausible (eg, that no prophylaxis and mechanical prophylaxis strategies should have the lowest risk of major bleeding).
Venous #thromboembolism prophylaxis strategies for people undergoing elective total #knee replacement: a systematic review and network meta-analysis
https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30155-3/fulltext
Risk of bias ranged from very low to high. Rivaroxaban ranked first for prevention of deep vein thrombosis (RR 0·12 [95% CrI 0·06–0·22]). Low molecular weight heparin (LMWH; standard prophylactic dose, 28–35 days) ranked first in the pulmonary embolism network (RR 0·02 [95% CrI 0·00–3·86]) and LMWH (low prophylactic dose, 10–14 days) ranked first in the major bleeding network (odds ratio 0·08 [95% CrI 0·00–1·76]), but the results for pulmonary embolism and major bleeding are highly uncertain.
Interpretation
Single prophylaxis strategies are more effective in prevention of deep vein thrombosis in the elective total knee replacement population than combination strategies, with rivaroxaban being the most effective. The results of the pulmonary embolism and major bleeding meta-analyses are uncertain and no clear conclusion can be made other than what is biologically plausible (eg, that no prophylaxis and mechanical prophylaxis strategies should have the lowest risk of major bleeding).
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Association of #Testosterone Therapy With Risk of Venous #Thromboembolism Among Men With and Without #Hypogonadism
..A total of 39 622 men (mean [SD] age, 57.4 [14.2] years) were enrolled in the study, and 3110 men (7.8%) had evidence of hypogonadism. In age-adjusted models, testosterone therapy use in all case periods was associated with a higher risk of VTE in men with (odds ratio [OR], 2.32; 95% CI, 1.97-2.74) and without (OR, 2.02; 95% CI, 1.47-2.77) hypogonadism. Among men without hypogonadism, the point estimate for testosterone therapy and VTE risk in the 3-month case period was higher for men younger than 65 years (OR, 2.99; 95% CI, 1.91-4.68) than for older men (OR, 1.68; 95% CI, 0.90-3.14), although this interaction was not statistically significant (P = .14).
Conclusions and Relevance Testosterone therapy was associated with an increase in short-term risk for VTE among men with and without hypogonadism, with some evidence that the association was more pronounced among younger men. These findings suggest that caution should be used when prescribing testosterone therapy.
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091
Association of #Testosterone Therapy With Risk of Venous #Thromboembolism Among Men With and Without #Hypogonadism
..A total of 39 622 men (mean [SD] age, 57.4 [14.2] years) were enrolled in the study, and 3110 men (7.8%) had evidence of hypogonadism. In age-adjusted models, testosterone therapy use in all case periods was associated with a higher risk of VTE in men with (odds ratio [OR], 2.32; 95% CI, 1.97-2.74) and without (OR, 2.02; 95% CI, 1.47-2.77) hypogonadism. Among men without hypogonadism, the point estimate for testosterone therapy and VTE risk in the 3-month case period was higher for men younger than 65 years (OR, 2.99; 95% CI, 1.91-4.68) than for older men (OR, 1.68; 95% CI, 0.90-3.14), although this interaction was not statistically significant (P = .14).
Conclusions and Relevance Testosterone therapy was associated with an increase in short-term risk for VTE among men with and without hypogonadism, with some evidence that the association was more pronounced among younger men. These findings suggest that caution should be used when prescribing testosterone therapy.
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2754091
Jamanetwork
Testosterone Therapy and Venous Thromboembolism Risk in Men With and Without Hypogonadism
This case-crossover study assesses whether testosterone therapy is associated with short-term risk of venous thromboembolism in men with and without hypogonadism.
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Safety and efficacy of high-dose unfractionated #heparin versus high-dose enoxaparin for venous #thromboembolism prevention in morbidly obese hospitalized patients
..A single-center retrospective observational study was conducted in morbidly obese (body mass index ≥ 40 kg/m2) hospitalized patients who received either high-fixed dose enoxaparin (40 mg every 12 hours) or unfractionated heparin (7,500 units every 8 hours) for venous thromboembolism prophylaxis.
..In the 305 patients included (n=190 unfractionated heparin, n=115 enoxaparin), the incidence of major bleeding was significantly higher in the unfractionated heparin group (OR 1.85, 95% CI 1.07-3.13; p=0.025), with no significant difference in the incidence of venous thromboembolism diagnosed during hospitalization. The only independent predictors of major bleeding were intensive care acuity (OR 3.32, 95% CI 1.91-5.78; p<0.001) and selection of unfractionated heparin rather than enoxaparin for venous thromboembolism prophylaxis (OR 2.16, 95% CI 1.22-3.82; p=0.008).
Conclusion
High-fixed dose unfractionated heparin for venous thromboembolism prophylaxis may lead to a higher risk of major bleeding events in morbidly obese patients compared to high-fixed dose enoxaparin.
https://bit.ly/35Jf6AM
Safety and efficacy of high-dose unfractionated #heparin versus high-dose enoxaparin for venous #thromboembolism prevention in morbidly obese hospitalized patients
..A single-center retrospective observational study was conducted in morbidly obese (body mass index ≥ 40 kg/m2) hospitalized patients who received either high-fixed dose enoxaparin (40 mg every 12 hours) or unfractionated heparin (7,500 units every 8 hours) for venous thromboembolism prophylaxis.
..In the 305 patients included (n=190 unfractionated heparin, n=115 enoxaparin), the incidence of major bleeding was significantly higher in the unfractionated heparin group (OR 1.85, 95% CI 1.07-3.13; p=0.025), with no significant difference in the incidence of venous thromboembolism diagnosed during hospitalization. The only independent predictors of major bleeding were intensive care acuity (OR 3.32, 95% CI 1.91-5.78; p<0.001) and selection of unfractionated heparin rather than enoxaparin for venous thromboembolism prophylaxis (OR 2.16, 95% CI 1.22-3.82; p=0.008).
Conclusion
High-fixed dose unfractionated heparin for venous thromboembolism prophylaxis may lead to a higher risk of major bleeding events in morbidly obese patients compared to high-fixed dose enoxaparin.
https://bit.ly/35Jf6AM
Clinical Effectiveness and Safety of #Aspirin for Venous #Thromboembolism Prophylaxis After Total Hip and Knee Replacement
https://2medical.news/2020/03/12/clinical-effectiveness-and-safety-of-aspirin-for-venous-thromboembolism-prophylaxis-after-total-hip-and-knee-replacement/
Patients undergoing total hip replacement (THR) and total knee replacement (TKR) receive venous thromboembolism (VTE) pharmacoprophylaxis. It is unclear which anticoagulant is preferable. Observational data suggest aspirin provides effective VTE prophylaxis.. ..The RR of VTE after THR and TKR was 1.12 (95% CI, 0.78-1.62) for aspirin compared with other anticoagulants. Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04; 95% CI, 0.72-1.51) and …
https://2medical.news/2020/03/12/clinical-effectiveness-and-safety-of-aspirin-for-venous-thromboembolism-prophylaxis-after-total-hip-and-knee-replacement/
Patients undergoing total hip replacement (THR) and total knee replacement (TKR) receive venous thromboembolism (VTE) pharmacoprophylaxis. It is unclear which anticoagulant is preferable. Observational data suggest aspirin provides effective VTE prophylaxis.. ..The RR of VTE after THR and TKR was 1.12 (95% CI, 0.78-1.62) for aspirin compared with other anticoagulants. Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04; 95% CI, 0.72-1.51) and …
American Society of Hematology 2020 guidelines for management of venous #thromboembolism: treatment of deep vein #thrombosis and pulmonary #embolism
https://2medical.news/2020/10/11/american-society-of-hematology-2020-guidelines-for-management-of-venous-thromboembolism-treatment-of-deep-vein-thrombosis-and-pulmonary-embolism/
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.. ..Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR …
https://2medical.news/2020/10/11/american-society-of-hematology-2020-guidelines-for-management-of-venous-thromboembolism-treatment-of-deep-vein-thrombosis-and-pulmonary-embolism/
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually.. ..Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR …
American Society of Hematology 2021 guidelines for management of venous #thromboembolism: prevention and treatment in patients with #cancer
https://2medical.news/2021/03/05/american-society-of-hematology-2021-guidelines-for-management-of-venous-thromboembolism-prevention-and-treatment-in-patients-with-cancer/
Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer. Methods: ASH formed …
https://2medical.news/2021/03/05/american-society-of-hematology-2021-guidelines-for-management-of-venous-thromboembolism-prevention-and-treatment-in-patients-with-cancer/
Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer. Methods: ASH formed …
Long-Term Risk for Major #Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous #Thromboembolism
https://2medical.news/2021/09/18/long-term-risk-for-major-bleeding-during-extended-oral-anticoagulant-therapy-for-first-unprovoked-venous-thromboembolism/
https://2medical.news/2021/09/18/long-term-risk-for-major-bleeding-during-extended-oral-anticoagulant-therapy-for-first-unprovoked-venous-thromboembolism/
2Medical.News
Long-Term Risk for Major #Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous #Thromboembolism
The long-term risk for major bleeding in patients receiving extended (beyond the initial 3 to 6 months) anticoagulant therapy for a first unprovoked venous thromboembolism (VTE) is uncertain. Purpo…
#Statin Use and the Risk of Venous #Thromboembolism in Women Taking #Hormone Therapy
https://2medical.news/2023/12/20/statin-use-and-the-risk-of-venous-thromboembolism-in-women-taking-hormone-therapy/
https://2medical.news/2023/12/20/statin-use-and-the-risk-of-venous-thromboembolism-in-women-taking-hormone-therapy/
2Medical.News
#Statin Use and the Risk of Venous #Thromboembolism in Women Taking #Hormone Therapy
Although hormone therapy (HT) in perimenopausal women is associated with increased risk for venous thromboembolism (VTE), it is unclear to what extent statins may mitigate this HT-associated risk.O…