Inferior vena cava filters placed prophylactically in patients hospitalized for trauma prevented symptomatic pulmonary embolism in those patients with persistent contraindications to anticoagulation, in a significant randomized trial. However, prophylactic IVC filter placement for all post-trauma patients did not improve outcomes generally. Trauma teams have always faced a difficult dilemma in the prevention and treatment [… read more]
by Nicole Lou, Contributing Writer, MedPage Today HONOLULU — Andexanet alfa (Andexxa), the reversal agent for anticoagulants in the factor Xa inhibitor class, worked for patients who developed acute major bleeding while on one of these agents, the full report of the ANNEXA-4 study confirmed. A bolus of the antidote saw median anti-factor Xa activity drop more [… read more]
The FDA is advising physicians that in post-approval data, 30-day survival rates with Abiomed’s Impella RP right ventricular assist device have been only 17%, compared to 73% in the RECOVER RIGHT study leading to the device’s approval in 2017. There were only 60 patients in the post-approval study, who had significantly worse clinical status at [… read more]
About one in five patients with cancer will develop pulmonary embolism (PE) or deep venous thrombosis (DVT), together called venous thromboembolism (VTE). Cancer patients who develop VTE are four times more likely to have experience another (recurrent) DVT or PE. Twice-daily injections of enoxaparin are advised for patients with cancer-related DVT/PE, or who are at [… read more]
Oral Anticoagulants in the ICU: A summary of the evidence for efficacy in atrial fibrillation, venous thromboembolism, and unique clinical cases Direct oral anticoagulants (DOACs) are recommended as the preferred treatment for venous thromboembolism (VTE) and as a first-line option for stroke prevention in nonvalvular atrial fibrillation (NVAF), but warfarin may be preferred in certain [… read more]
As the use of chest CT-angiograms in emergency departments and medical wards has risen by more than tenfold, so has the discovery of small pulmonary emboli of unclear clinical significance. These PEs are often isolated to distal (subsegmental) branches of the pulmonary artery, without concurrent deep venous thrombosis (DVT). Small distal PEs may be incidentally [… read more]
by Nicole Lou, Contributing Writer, MedPage Today Researchers concluded from a large retrospective study that pulmonary embolism is unlikely to cause syncope that results in a trip to the emergency room. Fewer than 1% of nearly 1.7 million patients treated at emergency departments for syncope had pulmonary embolism, according to databases from Canada, Denmark, Italy, and the [… read more]
The new generation of oral anticoagulants have revolutionized management of venous thromboembolism and atrial fibrillation. The changes in clinical practice have also created new questions and confusion around management of bleeding associated with these newer anticoagulants. The American College of Cardiology issued an expert consensus document in December 2017 to help guide physicians on the [… read more]
Most patients with cancer-associated deep venous thrombosis (DVT) or pulmonary embolism (PE) in the U.S. are treated indefinitely with subcutaneous injections of low-molecular weight heparin (LMWH), like enoxaparin. LMWH has been shown to be better than warfarin at preventing DVT/PE in cancer patients, with similar rates of bleeding. A new generation of oral anticoagulants have [… read more]
by Crystal Phend, Senior Associate Editor, MedPage Today Thrombolytics delivered to acute proximal deep-vein thrombus (DVT) with clot removal did not reduce the risk of post-thrombotic syndrome but did raise major bleeding risk over anticoagulant treatment alone in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) clinical trial. The proportion of patients with post-thrombotic [… read more]
By Scott Aberegg, M.D., M.P.H. This post is going to be an in-depth “journal club” style analysis of the PROPER trial. In this week’s JAMA, Freund et al report the results of the PROPER randomized controlled trial of the PERC (pulmonary embolism rule -out criteria) rule for safely excluding pulmonary embolism (PE) in the emergency department (ED) [… read more]
By Salynn Boyles, Contributing Writer, MedPage Today A clinical assessment protocol proved to be as effective as blood testing and CT imaging in the emergency department setting for ruling out pulmonary embolism in very low-risk patients in a newly reported French clinical trial. The crossover cluster-randomized PROPER study was conducted at 14 emergency departments (EDs) in France [… read more]
The long-term management of recurrent venous thromboembolism continues to evolve with the FDA’s approval of once-daily low-dose rivaroxaban, now indicated for patients with recurrent deep venous thrombosis or pulmonary embolism who have completed at least six months of anticoagulation. FDA approved low-dose rivaroxaban based on data from 3,395 patients in the EINSTEIN-CHOICE study. Both 20 [… read more]
New-generation oral anticoagulants (NOACs) like dabigatran, rivaroxaban, and apixaban all had similar efficacy and bleeding risk compared to warfarin in the randomized trials that led to their FDA approval. That didn’t stop trial lawyers from filing bundles of lawsuits on behalf of patients experiencing hemorrhages after taking NOACs. (The large brand-name pharmaceutical manufacturers advertising new [… read more]
In pulmonary embolism (PE), right ventricular (RV) strain on transthoracic echocardiography increases the likelihood of shock and mortality. One study showed among patients with PE and normal blood pressure, 10% of those with RV strain on echocardiogram developed shock, and 5% died in hospital. Those without RV strain maintained their blood pressure and survived (but important [… read more]
HIT Overview Heparin-induced thrombocytopenia (HIT) is a dangerous complication of heparin exposure. In HIT, the body creates an autoantibody against the complex of platelet factor 4 bound to heparin. The anti-PF4 autoantibodies can activate platelets and cause life- and limb-threatening thrombosis in arteries and veins. Platelets generally fall by more than 50% five to ten [… read more]
The US Food and Drug Administration (FDA) approved betrixaban (Bevyxxa), a new oral anticoagulant for prevention of venous thromboembolism (VTE) in hospitalized medical patients with risk factors for DVT/PE. With betrixaban, manufacturer Portola will seek to expand a tiny market niche it could immediately dominate: prophylaxis of DVT/PE extending for about a month after hospital [… read more]
Low molecular weight heparin (LMWH) at preventive doses after arthroscopic knee surgery or leg casting did not prevent venous thromboembolism (DVT or PE), in two Dutch randomized trials. The study helps fill a large gap in knowledge regarding risks and benefits of prophylactic anticoagulation in patients undergoing these procedures. In one (POT-KAST), 1,543 patients received [… read more]
Inferior vena cava filters (IVCF) are placed to prevent deep venous thromboses (DVT) from traveling to the heart and lungs, causing pulmonary embolism (PE). IVC filters’ rationale makes sense, but despite their wide use, the benefits and risks of IVCF remain unclear. With about 50,000 IVC filters placed annually in the U.S., that’s a lot of unclarity. [… read more]
By Jon-Emile S. Kenny [@heart_lung] “The only way to get rid of temptation is to yield to it.” -Oscar Wilde The Case A 76 year old woman without known medical comorbidity is ambulating along 7th avenue, rounding the corner where St. Vincent’s Hospital once operated. It is an exceptionally humid August afternoon and she has not [… read more]
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