Apixaban (Eliquis) Prevents Recurrent DVT-PE Long-Term People with unprovoked venous thromboembolic disease (pulmonary embolism or deep venous thrombosis, or DVT) are at high risk for recurrence, and current ACCP guidelines advise consideration of “indefinite” anticoagulation. Warfarin (Coumadin) is a wonder drug efficacy-wise, reducing the risk of pulmonary embolism and deep venous thrombosis by ~90%. However, [... read more]
image: Wikimedia Inferior Vena Cava Filters: What’s the Harm? Do inferior vena cava filters actually create more harm than health? That’s the provocative question being posed by authors and editorialists in JAMA Internal Medicine. Inferior vena cava filters are frequently placed after a pulmonary embolism (PE) or deep venous thrombosis (DVT) in patients with a [... read more]
Why Patients with PEs Shouldn’t Love the Weekend Hospitals big and small struggle with weekend staffing models. Mortality has been shown to be higher on the weekend for several common life-threatening illnesses, including CHF exacerbations, acute MI, upper GI bleeds and intracerebral hemorrhage. All these conditions are known to benefit from early intervention; however, whether [... read more]
In Most Patients with Pulmonary Embolism, Central Clot is Worse than Peripheral by Brett Ley, MD Pulmonary embolism (PE) presents with a wide range of clinical severity and course. Management decisions (level of care, length of observation, and aggressive therapies such as thrombolysis) are generally based on a patient’s risk of a poor outcome. Guidelines recommend risk [... read more]
Xarelto (rivaroxaban): New FDA Indication for DVT, PE The U.S. Food and Drug Administration (FDA) approved Bayer’s Xarelto (rivaroxaban) for a new indication for treating deep vein thrombosis (DVT) or pulmonary embolism (PE), and for long-term prophylaxis of recurrent DVT and PE. Xarelto already had FDA approval for prevention of DVTs and PEs after knee or [... read more]
(image: InPharm) Rivaroxaban (Xarelto) was noninferior to standard treatment (heparin and warfarin) in preventing recurrent VTE in patients with acute pulmonary embolism (PE), in the large EINSTEIN-PE randomized trial published in the April 5 New England Journal of Medicine. A once-daily oral factor Xa inhibitor that has already been demonstrated to be noninferior for treatment [... read more]
(image: Rex Parker) Among people with unprovoked deep venous thrombosis (DVT) or pulmonary embolism (PE), 1 in 5 will experience another DVT or PE within 2 years after stopping anticoagulation with warfarin (Coumadin). For this reason, the ACCP’s recommendations for treatment of unprovoked proximal DVT or PE suggest consideration of an “indefinite” period of anticoagulation [... read more]
Does Enoxaparin Prophylaxis Really Help Most Hospitalized Patients? A huge randomized trial (LIFENOX) stunned experts by showing no benefit of enoxaparin prophylaxis in preventing pulmonary embolism or all-cause mortality in acutely ill medical patients, compared to knee-length graduated compression stockings alone. Ajay Kakkar, Claudio Cimminiello, Jean-Francois Bergmann et al report their surprising results in the [... read more]
Is In-Flight Oxygen for Pulmonary Hypertension Necessary? After finding a high rate of symptoms among people with pulmonary hypertension during commercial air flights, Nareg Roubinian, C. Gregory Elliott, and Hubert Chen are recommending that everyone with significant pulmonary hypertension planning to take a flight longer than 2.5 hours should be evaluated for supplemental in-flight oxygen. [... read more]
Acute Deep Venous Thrombosis (DVT) of the Arm: from the ACCP Guidelines, 9th Ed. The ACCP published its 9th edition of their clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) in February 2012, and we’re summarizing the 801-page long document by topic. (See also the other sections of the 9th edition ACCP recommendations.) Here we review the section on [... read more]
Acute Deep Venous Thrombosis (DVT) of the Leg: Initial Anticoagulant Therapy from the ACCP Guidelines, 9th Ed. The ACCP‘s 9th edition of their clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012, and we’re summarizing the 801-page long document piece by piece. (See also the other sections of the 9th edition ACCP recommendations.) Here [... read more]
Superior Vena Cava Syndrome: A Cancer-Related Medical Emergency (More PulmCCM Topic Updates) Multiple cancers are expected to rise in prevalence in the U.S. over the coming decades, and so is the risk for cancer-related medical emergencies. For a few, superior vena cava syndrome (SVC syndrome) will be the first manifestation of their cancer. It’s important [... read more]
Pulmonary Hypertension And Pulmonary Vascular Disease Review 2012 (More PulmCCM Topic Updates) This document is periodically updated as new research findings are published. The published date reflects the most current update. Please suggest articles for inclusion in future versions of this document in the comments or by e-mail. Chronic Thromboembolic Pulmonary Hypertension Update The mechanism [... read more]
Prevention & Treatment of DVT/PE in Pregnant Women from the ACCP Guidelines, 9th Ed. The ACCP’s recommendation classification system: 1 = “recommendation” 2 = “suggestion” A = based on strong evidence from randomized trials B = moderate evidence that may include randomized trials or observational studies C = weak evidence, mostly consensus opinion Low-Molecular Weight Heparin [... read more]
Diagnosis of Deep Venous Thrombosis (DVT) of the Lower Extremity from the ACCP / Chest Guidelines, 9th Ed. The ACCP recommendations for diagnosis of DVT of the leg are based on these principles of safety: Reducing overall false-negatives to 2% or less (as defined by symptomatic DVT or PE within 3-6 months after a negative test); [... read more]
Inferior Vena Cava Filters for Prevention of Pulmonary Embolism from the ACCP Guidelines, 9th Ed. Inferior vena cava filters should generally be placed in patients with acute pulmonary embolism (PE) or deep venous thrombosis (DVT) who have a contraindication to anticoagulation, according to the ACCP’s recommendations. The ACCP recommends against placing an IVC filter in patients [... read more]
Thrombolytics for Acute Pulmonary Embolism from the ACCP Guidelines, 9th Ed. The ACCP’s recommendation classification system: 1 = “recommendation” 2 = “suggestion” A = based on strong evidence from randomized trials B = moderate evidence that may include randomized trials or observational studies C = weak evidence, mostly consensus opinion Which patients with acute pulmonary embolism [... read more]
Treating Acute Pulmonary Embolism with Anticoagulant Therapy from the ACCP Guidelines, 9th Ed. The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012, and we’ll be summarizing the 801-page long document piece by piece. (See also our summaries of the other sections of the 9th edition recommendations.) [... read more]
Westermark sign: a focal area of decreased lucency on a plain chest film with an abrupt cut-off in the pulmonary artery, corresponding to a central occlusive pulmonary embolism. A.S. Krishnan and Tristan Barrett share a nice example of the Westermark sign in the March 15 New England Journal.
Managing Anticoagulation in the Perioperative Period: ACCP Guidelines from the ACCP Guidelines, 9th Ed. The ACCP‘s new 9th edition of their authoritative clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE) were published in February 2012, and we’ll be summarizing the 801-page long document piece by piece. (See also “Preventing DVT-PE in hospitalized nonsurgical [... read more]