Aujesky et al randomized 344 people in 19 European emergency departments with low-risk pulmonary embolism to either be sent home with enoxaparin and warfarin within one day, or to be treated until therapeutic on warfarin in-hospital. They were then treated for 90 days. One of 171 home-treated patients developed recurrent VTE, while none of the [… read more]
Boutitie et al analyzed pooled anticoagulation clinic data from 2,925 people with a first deep venous thrombosis or pulmonary embolism in the UK. They found that the recurrence risk after stopping anticoagulation at 3 months was equivalent to stopping at 6 months. Proximal DVTs were more likely to recur than distal DVTs. BMJ 2011;342:d3036. FREE [… read more]
Douma et al compared the Wells score, Geneva score, and the simplified versions of each, combined with D-dimer, on a prospective cohort of 807 patients with suspected PE (~23% of whom were found to have PE). With a negative D-dimer and a low-probability score using any rule, risk of pulmonary embolism was ~0.5%. However, only [… read more]
Salaun et al publish their experience using a simple algorithm for management of 321 consecutive patients with suspected pulmonary embolism at one center in France. The tool sought to avoid CT-angiography (and associated radiation) wherever possible, instead favoring leg ultrasounds and ventilation-perfusion scans. Only the indeterminate cases (a mere 35, or 11%) underwent CT-A. In [… read more]
Venous thromboembolism, long term management of: Bauer K, JAMA 2011;305:1336-1345.
Drospirenone is the new progesterone analog in heavily marketed new oral contraceptive pills (trade names Yaz, Yasmin, Angelique). Using a large insurance claims database, Jick et al identified 186 cases of DVT or PE in women aged 15-44 taking oral contraceptives and compared them to controls. Those taking drospirenone-containing OCPs had a nonfatal DVT/PE incidence [… read more]
DVT of the upper extremity: Kucher N, NEJM 2011;364:861-869.
ICU patients have a 5-10% risk of deep venous thrombosis, even with appropriate prophylaxis. Ultrasound screening can detect many of these asymptomatic and clinically unsuspected DVTs. However, since many DVTs disappear without incident, and complications can result from additional testing and treatment with anticoagulation, and all of this costs money, the best approach to prevention [… read more]