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Lobastov K, Dubar E, Schastlivtsev I, Bargandzhiya A. A systematic review and meta-analysis for the association between duration of anticoagulation therapy and the risk of venous thromboembolism in patients with lower limb superficial venous thrombosis. J Vasc Surg Venous Lymphat Disord 2024; 12:101726. [PMID: 38008180 DOI: 10.1016/j.jvsv.2023.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/11/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The aim of this study was to determine the association between the duration of systemic anticoagulation therapy (ACT) and the risk of further venous thromboembolism (VTE) in patients with superficial venous thrombosis (SVT). METHODS A systematic review and meta-analysis were performed using searches of Medline and Cochrane Library databases in September 2023. Papers that provided VTE incidence within mid-term follow-up of ≥45 days in patients who received any ACT were included. Patients were categorized into subgroups according to the course of treatment: (1) no ACT (0 days); (2) ACT of ≤14 days; (3) ACT of 15 to 30 days; (4) ACT of 31 to 45 days; and (5) ACT of >45 days. Reported events were transformed to events per 100 patient-years, and a random-effects model was used to calculate pooled rates for proportions. The primary outcome (VTE) was a combination of SVT progression or recurrence with the occurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE). Secondary outcomes included major and clinically relevant non-major or minor bleeding. RESULTS Twenty-four studies (10 randomized controlled trials and 14 cohort studies) combining outcomes in 12,341 patients were included in the quantitative synthesis. Minimum VTE and SVT recurrence or progression rates were observed with the ACT duration of 31 to 45 days of 16.2 (95% confidence interval [CI], 10.4-23.3) and 8.2 (95% CI, 3.1-15.8) events per 100 patient-years, respectively. Minimum DVT and PE rates observed with the treatment duration of 15 to 30 days were 5.5 (95% CI, 2.8-9.1) and 0.9 (95% CI, 0.5-1.3) events per 100 patient-years, respectively. Short-term treatment of ≤14 days was associated with the highest rates of VTE of 59.7 (95% CI, 37.7-86.4), DVT of 13.7 (95% CI, 9.6-18.4), and PE of 3.1 (95% CI, 1.4-5.6) events per 100 patient-years. Major bleeding rates were unrelated to the duration of ACT and did not exceed 0.5 events per 100 patient-years. The highest rate of clinically relevant non-major or minor bleeding was observed with ACT duration of 31 to 45 days of 14.2 (95% CI, 5.5-26.8) events per 100 patient-years. The most common risk factors for VTE included male sex, cancer, personal history of DVT, PE, or SVT, and thrombosis of non-varicose veins. CONCLUSIONS Prolonged systemic anticoagulation is associated with the tendency to decrease VTE rates in patients with lower limb SVT.
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Affiliation(s)
- Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia.
| | - Emel Dubar
- City Clinical Hospital №7 named after S.S. Yudin, Moscow, Russia
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2
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Arnold MJ. Thromboembolic Disease. Prim Care 2024; 51:65-82. [PMID: 38278574 DOI: 10.1016/j.pop.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Venous thromboembolism (VTE) encompasses deep vein thrombosis and pulmonary embolism, both of which can present on a spectrum from subtle symptoms to life- and limb-threatening emergencies. Some risk factors for VTE overlap cardiovascular risk factors and statin therapy can somewhat reduce the VTE risk. When presentations are not life-threatening, clinical prediction scores using the Well's criteria are best used to determine diagnostic testing. The mainstay of VTE treatment is anticoagulant therapy, although life- and limb-threatening presentations can also require thrombolytic therapy.
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Affiliation(s)
- Michael J Arnold
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 40814, USA.
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3
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Jørgensen CT, Brækkan SK, Førsund E, Pettersen HH, Tjønnfjord E, Ghanima W, Tavoly M. Incidence of venous thromboembolism, recurrence, and bleeding after isolated superficial vein thrombosis: findings from the Venous Thrombosis Registry in Østfold Hospital. J Thromb Haemost 2024; 22:526-533. [PMID: 37913911 DOI: 10.1016/j.jtha.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND There are limited data on the long-term risk of venous thromboembolism (VTE) after high-risk isolated superficial vein thrombosis (iSVT) treated with anticoagulants. OBJECTIVES To determine the short- and long-term risk of VTE and iSVT recurrence after cessation of anticoagulant treatment and to calculate 45-day cumulative bleeding incidence in patients with iSVT. METHODS Between January 2014 and December 2021, 229 patients with high-risk iSVT (ie, thrombus length ≥5cm), without active cancer, with no history of VTE or iSVT, and who had received anticoagulant treatment for the iSVT were identified through the Venous Thrombosis Registry in Østfold Hospital (TROLL registry), Norway. Cumulative incidences of VTE and iSVT recurrence, as well as cumulative incidences of major and clinically relevant nonmajor bleeding events, were assessed. RESULTS Median age was 60 years (IQR, 48-71), and 125 (55%) were women. Most patients were treated with direct oral anticoagulants (74%), and of these, 79% received a dose of rivaroxaban 10 mg daily. Low-molecular-weight heparin was given to 26% of the patients. The 1- and 5-year cumulative incidences of VTE after iSVT were 4.6% (95% CI, 2.5-8.3) and 15.9% (95% CI, 10.8-22.9), respectively. Further, the 1- and 5-year cumulative incidences of iSVT recurrence were 6.5% (95% CI, 3.9-10.7) and 15.9% (95% CI, 10.8-23.1), respectively. The overall 45-day cumulative incidence of major and clinically relevant nonmajor bleeding events was 0.4% (95% CI, 0.06-3.06) and 1.8% (95% CI, 0.7-4.6), respectively. No major bleeding events were observed in patients treated with direct oral anticoagulants. CONCLUSION Despite anticoagulant treatment, the risk of VTE after high-risk iSVT was substantial, while bleeding complications were low.
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Affiliation(s)
- Camilla Tøvik Jørgensen
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Sigrid Kufaas Brækkan
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Thrombosis Research Group, Department of Clinical Medicine, The University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Eli Førsund
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway
| | | | - Eirik Tjønnfjord
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway
| | - Waleed Ghanima
- Department of Research, Østfold Hospital, Sarpsborg, Norway; Clinic of Internal Medicine, Østfold Hospital Sarpsborg, Norway; Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mazdak Tavoly
- Department of Research, Østfold Hospital, Sarpsborg, Norway; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rabe E, Hoffmann U, Schimke A, Heinken A, Langer F, Noppeney T, Pittrow D, Klotsche J, Gerlach HE, Bauersachs R. Determinants of Late Venous Thromboembolic Events After Acute Isolated Superficial Vein Thrombosis in Daily Practice: 12 Month Results of the INSIGHTS-SVT Study. Eur J Vasc Endovasc Surg 2023; 66:697-704. [PMID: 37573936 DOI: 10.1016/j.ejvs.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/11/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Long term incidence of symptomatic venous thromboembolism (VTE) and bleeding events in patients with superficial vein thrombosis (SVT) was investigated. METHODS In this prospective, observational study, patients with acute SVT were treated at the discretion of the responsible physician. The primary efficacy outcome was symptomatic VTE including deep vein thrombosis (DVT), pulmonary embolism (PE), and recurrent or extending SVT. The primary safety outcome was clinically relevant bleeding, recorded at periodic clinic visits over a 12 month period. RESULTS The mean age of 872 patients with 12 month follow up was 60.6 ± 14.5 years, 64.5% were female, 80.1% had chronic venous disease (defined as chronic venous insufficiency and or varicose veins), and 41.9% had a history of VTE. They were receiving fondaparinux in 62.1% (mean duration 34.9 ± 15.7 days), low molecular weight heparin (LMWH) in 25.0% (mean duration 26.2 ± 23.2 days), any other anticoagulants in 6.2%, and no anticoagulant in 6.7%. At 12 months, 108 patients (14.3%) achieved the primary efficacy outcome. The most common VTE event was recurrent or extending SVT in 11.0%, followed by symptomatic DVT in 2.7%, symptomatic PE in 2.4%, hospitalisation due to VTE in 1.8%, and death in 1.1%. Clinically relevant bleeding events occurred in 2.1% of patients, and major bleedings in 0.3%. By drug, the rate of the primary efficacy outcome was highest in the LMWH group (22.4%) and lowest in the fondaparinux group (10.4%). In a multivariable model, patients with events between three months and 12 months were significantly more likely to have higher BMI (hazard ratio [HR] 1.06; p = .002), history of VTE (HR 2.89; p = .002), and severe systemic infections (HR 7.59; p = .006). CONCLUSION The risk of symptomatic VTE remained elevated over 12 months of follow up. Therefore, anticoagulation beyond 45 days may be considered in patients with risk factors. [ClinicalTrials.gov identifier: NCT02699151.].
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Affiliation(s)
- Eberhard Rabe
- Praxis für Dermatologie & Phlebologie PD Dr. Pannier, Bonn, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilian University, Munich, Germany
| | | | | | - Florian Langer
- II. Medical Clinic and Policlinic, Centre for Oncology, University Medical Centre Eppendorf, Hamburg, Germany
| | - Thomas Noppeney
- Department of Vascular and Endovascular Surgery, University Hospital, Regensburg, Germany
| | - David Pittrow
- Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany; Innovation Centre Real World Evidence, GWT-TUD GmbH, Dresden, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, ein Institut der Leibniz-Gemeinschaft, Epidemiology and Health Services Research, Berlin, Germany
| | | | - Rupert Bauersachs
- Center for Thrombosis and Haemostasis, University Medical Centre Mainz, Mainz, Germany; Cardioangiologisches Centrum Bethanien CCB, Standort AGAPLESION Bethanien Krankenhaus, Frankfurt am Main, Germany.
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Debourdeau P, Bertoletti L, Font C, López-Núñez JJ, Gómez-Cuervo C, Mahe I, Otero-Candelera R, Adarraga MD, López-Miguel P, Monreal M. Three-Month Outcomes in Cancer Patients with Superficial or Deep Vein Thrombosis in the Lower Limbs: Results from the RIETE Registry. Cancers (Basel) 2023; 15:cancers15072034. [PMID: 37046695 PMCID: PMC10093050 DOI: 10.3390/cancers15072034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: The clinical characteristics and outcomes of cancer patients with lower-limb isolated superficial vein thrombosis (SVT) have not been consistently evaluated. Methods: We used data in the RIETE registry to compare the clinical characteristics and 90-day outcomes for patients with: (1) active cancer and lower-limb SVT; (2) active cancer and lower-limb deep vein thrombosis (DVT); (3) lower-limb SVT without cancer. The primary outcomes included subsequent symptomatic SVT, DVT or pulmonary embolism (PE). Secondary outcomes were major bleeding and death. Results: From March 2015 to April 2021, there were 110 patients with cancer and SVT, 1695 with cancer and DVT, and 1030 with SVT but no cancer. Most patients in all subgroups (93%, 99% and 96%, respectively) received anticoagulants, while those with SVT received lower daily doses of low-molecular-weight heparin (114 ± 58, 163 ± 44, and 106 ± 50 IU/kg, respectively). During the first 90 days, 101 patients (3.6%) developed subsequent VTE (PE 47, DVT 41, SVT 13), whereas 72 (2.5%) had major bleeding and 282 (9.9%) died. Among the three groups, 90-day events were, respectively: VTE at rates of 7.3%, 4.0% and 2.4%; major bleeding at rates of 2.7%, 3.9% and 0.3%; mortality at rates of 8.2%, 16% and 0.3%. Between D90 and D180, only one SVT recurrence and one death occurred in SVT cancer patients. In multivariable analysis, cancer was associated with subsequent VTE (HR = 2.04; 1.15–3.62), while initial presentation as SVT or DVT were not associated with a different risk. Conclusions: The risk for subsequent VTE (including symptomatic SVT, DVT or PE) was similar in cancer patients with isolated SVT than in those with isolated DVT.
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6
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Leão RV, Bernal ECBA, Rodrigues MB, Amaral DT, de Paula Correa MF, Helito PVP. Venous thrombosis: a mimic of musculoskeletal injury on MR imaging. Skeletal Radiol 2022; 52:1263-1276. [PMID: 36534142 DOI: 10.1007/s00256-022-04258-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Clinical signs and symptoms of venous thrombosis and musculoskeletal pathologies frequently overlap. Sometimes, patients with venous thrombosis undergo MR examinations under an equivocal suspicion of muscle, tendon or articular injury. A low pretest clinical suspicion and lack of familiarity with the conventional MR imaging signs of venous thrombosis may result in failure to diagnose venous thrombosis, delaying treatment and raising morbimortality. In MR imaging, thrombosis presents as venous ectasia with intraluminal heterogeneous content. Small vein thrombosis is often identified as having a branching aspect. Perivenous edema and inflammatory soft tissue changes may be the most prominent findings. The purpose of this paper is to illustrate MR findings of venous thrombosis in patients who underwent MR examinations due to suspected musculoskeletal pathologies. Cases of venous thrombosis in different sites of the body diagnosed through MR are presented.
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Affiliation(s)
- Renata Vidal Leão
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil.
| | | | | | - Denise Tokechi Amaral
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
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7
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Karathanos C, Kakkos SK, Georgiadis G, Ioannou C, Vasdekis S, Chatzis D, Latzios P, Giannoukas AD. Risk of recurrent thromboembolic events according to treatment duration in patients with superficial vein thrombosis treated with intermediate dose of tinzaparin. Phlebology 2022; 38:141-149. [PMID: 36461172 PMCID: PMC10070553 DOI: 10.1177/02683555221143576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To evaluate the risk of symptomatic venous thromboembolism (VTE) recurrence at 3 months in relation to treatment duration, according to baseline risk factor profiles, in patients with superficial vein thrombosis (SVT) treated with intermediate dose of tinzaparin. METHODS We performed a pooled analysis on individual data from two prospective studies designed to assess the efficacy and safety of tinzaparin in intermediate dose (131 IU/kg) in patients with SVT. Treatment duration was at the treating physician's discretion. All patients were followed up for at least 3 months. RESULTS A total of 956 patients (65% female, mean age 58.7 ± 13.7 years) were included. The median treatment duration was 30 days (range, 3-200 days). History of deep vein thrombosis (DVT), location of SVT above the knee, and palpable induration were the only independent factors associated with prolonged treatment duration. During follow-up, 95.9% of patients were event free. Outcomes-related adverse events occurred in 39 (4.1%) patients and their median duration of treatment was 33 days (range, 7-200 days). Recurrent VTE events occurred in 33 patients, including 22 cases of SVT recurrence, 8 cases of DVT, and 1 case of pulmonary embolism. The median time to the event was 29 (6-113) days. Recurrent thromboembolic events were not related to treatment duration as occurred in 17 patients (51.5%) treated up to 30 days and in 16 patients (48.8%) received prolong treatment (p = .46). Length of thrombus at the index event was significantly associated with higher risk for VTE recurrence. CONCLUSIONS Intermediate dose of tinzaparin for 30 days is an effective and safe treatment for SVT. The risk of recurrent VTE events may be higher in patients with greater amount of thrombus at index event.
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Affiliation(s)
- Christos Karathanos
- Department of Vascular Surgery, 69176University Hospital of Larissa, Larissa, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, 37795University Hospital of Patras, Patras, Greece
| | - Georgios Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos Ioannou
- Department of Vascular Surgery, University Hospital of Heraklion, Crete, Greece
| | - Spyros Vasdekis
- Department of Vascular Surgery, "ATTIKON" University Hospital, Athens, Greece
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8
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Langer F, Gerlach HE, Schimke A, Heinken A, Hoffmann U, Noppeney T, Pittrow D, Klotsche J, Rabe E, Bauersachs R. Clinical outcomes of cancer-associated isolated superficial vein thrombosis in daily practice. Thromb Res 2022; 220:145-152. [DOI: 10.1016/j.thromres.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/15/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
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9
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Wilson S, Chen X, Cronin M, Dengler N, Enker P, Krauss ES, Laberko L, Lobastov K, Obi AT, Powell CA, Schastlivtsev I, Segal A, Simonson B, Siracuse J, Wakefield TW, McAneny D, Caprini JA, Caprini JA. Thrombosis prophylaxis in surgical patients using the Caprini Risk Score. Curr Probl Surg 2022; 59:101221. [PMID: 36372452 DOI: 10.1016/j.cpsurg.2022.101221] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Xialan Chen
- Beijing Shijitan Hospital, Capital Medical University, Beijing, P.R. China
| | - MaryAnne Cronin
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Nancy Dengler
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Paul Enker
- Zucker School of Medicine, Hofstra University, Uniondale, NY
| | - Eugene S Krauss
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Leonid Laberko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Andrea T Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Chloé A Powell
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Ayal Segal
- Department of Orthopedic Surgery, Syosset Hospital, Syosset, NY
| | - Barry Simonson
- Zucker School of Medicine, Hofstra University, Uniondale, NY
| | | | | | - David McAneny
- Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Joseph A Caprini
- Emeritus, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Chicago, IL
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10
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A Patient with Sickle Cell Disease and Recurrent Venous Thromboembolism after Renal Transplantation. THALASSEMIA REPORTS 2022. [DOI: 10.3390/thalassrep12030013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Venous thromboembolism (VTE) is a life-threatening complication, especially in case of recurrence. The appropriate duration of anticoagulant treatment following the first event is crucial. Risk factors that increase the risk of recurrence of VTE are many, and include medications, kidney disease, renal transplantation (RT), and a diagnosis of sickle cell disease (SCD). There are currently no guidelines that define the duration of anticoagulant therapy after the first event in a patient with RT. We report a case of recurring episodes of VTE after RT in a SCD patient. Our case suggests that the use of a long-term anticoagulant treatment may be recommended in patients with SCD and RT after the first event of VTE.
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12
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Antic D, Lefkou E, Otasevic V, Banfic L, Dimakakos E, Olinic D, Milić D, Miljić P, Xhepa S, Stojkovski I, Kozak M, Dimulescu DR, Preradović TK, Nancheva J, Pazvanska EE, Tratar G, Gerotziafas GT. Position Paper on the Management of Pregnancy-Associated Superficial Venous Thrombosis. Balkan Working Group for Prevention and Treatment of Venous Thromboembolism. Clin Appl Thromb Hemost 2022; 28:1076029620939181. [PMID: 35187959 PMCID: PMC8864277 DOI: 10.1177/1076029620939181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Venous thromboembolism (VTE) is a multifactorial disease that can possibly affect
any part of venous circulation. The risk of VTE increases by about 2 fold in
pregnant women and VTE is one of the major causes of maternal morbidity and
mortality. For decades superficial vein thrombosis (SVT) has been considered as
benign, self-limiting condition, primarily local event consequently being out of
scope of well conducted epidemiological and clinical studies. Recently, the
approach on SVT has significantly changed considering that prevalence of lower
limb SVT is twice higher than both deep vein thrombosis (DVT) and pulmonary
embolism (PE). The clinical severity of SVT largely depends on the localization
of thrombosis, when it concerns the major superficial vein vessels of the lower
limb and particularly the great saphenous vein. If untreated or inadequately
treated, SVT can potentially cause DVT or PE. The purpose of this review is to
discuss the complex interconnection between SVT and risk factors in pregnancy
and to provide evidence-based considerations, suggestions, and recommendations
for the diagnosis and treatment of this precarious and delicate clinical
entity.
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Affiliation(s)
- Darko Antic
- University Clinical Center of Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Eleftheria Lefkou
- Sorbonne University, INSERM, UMR_S 938, Research Group “Cancer,
Biology and Therapeutics - Cancer, Haemostasis, Angiogenesis” Centre de recherche
Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Paris, France
| | | | - Ljiljana Banfic
- Department of Cardiovascular Diseases, Zagreb University Hospital
Centre, School of Medicine, Croatia
| | - Evangelos Dimakakos
- Vascular Unit of 3rd Internal Medicine Department of the University
of Athens-Sotiria General Hospital, Athens, Greece
| | - Dan Olinic
- Medical Clinic No. 1, University of Medicine and Pharmacy,
Cluj-Napoca, Romania
| | | | - Predrag Miljić
- University Clinical Center of Serbia
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Sokol Xhepa
- Service of Vascular Surgery, University Hospital Center “Mother
Theresa” of Tirana, Albania
| | - Igor Stojkovski
- University Clinic for Oncology and Radiotherapy, Faculty of
Medicine, Ss Cyril and Methodius University of Skopje, Republic of North
Macedonia
| | - Matija Kozak
- University Medical Centre Ljubljana, Department for Vascular
Diseases, Ljubljana, Slovenia
| | - Doina Ruxandra Dimulescu
- University of Medicine and Pharmacy “Carol Davila” Bucharest,
Ponderas Academic Hospital Bucharest, Cardiology Department, Romania
| | | | - Jasminka Nancheva
- University Clinic for Orthopedic Diseases, Medical Faculty,
University “Ss. Cyril and Methodius” Skopje, Republic of North Macedonia
| | | | - Gregor Tratar
- Department of Angiology, University Medical Centre, Ljubljana,
Slovenia
| | - Grigoris T. Gerotziafas
- Sorbonne University, INSERM, UMR_S 938, Research Group “Cancer,
Biology and Therapeutics - Cancer, Haemostasis, Angiogenesis” Centre de recherche
Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, Paris, France
- Sorbonne University, INSERM, UMR_S 938, Research Group "Cancer,
Biology and Therapeutics - Cancer, Haemostasis, Angiogenesis" Centre de recherche
Saint-Antoine (CRSA), Institut Universitaire de Cancõrologie, Paris, France
- Grigoris T. Gerotziafas, MD, PhD, INSERM
U938 Bâtiment Kourilsky, 34 rue Crozatier, Hôpital Saint Antoine, Paris, Cedex
75012, France.
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13
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Dubois-Silva Á, Barbagelata-López C, Piñeiro-Parga P, Francisco I, Falgá C, Tirado R, Suriñach JM, Vela JR, Mella C, Quere I, Siniscalchi C, Monreal M. Prognostic Significance of Concomitant Superficial Vein Thrombosis in Patients with Deep Vein Thrombosis of the Lower Limbs. Thromb Haemost 2021; 121:1650-1659. [PMID: 33677826 DOI: 10.1055/a-1414-5055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prognostic significance of concomitant superficial vein thrombosis (SVT) in patients with lower-limb deep vein thrombosis (DVT) has not been consistently evaluated. METHODS We used the RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry to compare the rates of subsequent pulmonary embolism (PE), recurrent DVT, major bleeding or death in patients with lower-limb DVT, according to the presence or absence of concomitant SVT. RESULTS From March 2015 to May 2020, there were 8,743 patients with lower-limb DVT. Of these, 745 (8.5%) had concomitant SVT. Most patients (97.4% in both subgroups) received anticoagulant therapy (median duration: 138 vs. 147 days). During follow-up (median: 193 vs. 210 days), 156 (1.8%) patients developed subsequent PE, 336 (3.8%) had recurrent DVT, 201 (2.3%) had major bleeding and 844 (9.7%) died. Patients with concomitant SVT had a higher rate of subsequent PE (rate ratio [RR]: 2.11; 95% confidence interval [95%CI]: 1.33-3.24) than those with isolated DVT, with no significant differences in the rates of recurrent DVT (RR: 0.80; 95%CI: 0.50-1.21), major bleeding (RR: 0.77; 95%CI: 0.41-1.33) or death (RR: 0.81; 95%CI: 0.61-1.06). On multivariable analysis, patients with DVT and SVT concomitantly were at increased risk of subsequent PE during anticoagulation (adjusted hazard ratio [HR]: 2.23; 95%CI: 1.22-4.05) and also during the entire follow-up period (adjusted HR: 2.33; 95%CI: 1.49-3.66). CONCLUSION Patients with lower-limb DVT and SVT concomitantly are at increased risk of developing PE. Further studies are needed to externally validate our findings and to determine if these patients could benefit from a different management strategy.
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Affiliation(s)
- Álvaro Dubois-Silva
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain.,Universidade da Coruña, A Coruña, Spain
| | - Cristina Barbagelata-López
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
| | - Patricia Piñeiro-Parga
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, Spain
| | - Iria Francisco
- Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, Spain
| | - Conxita Falgá
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - Raimundo Tirado
- Department of Internal Medicine, Hospital Infanta Margarita, Córdoba, Spain
| | - José María Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Jerónimo Ramón Vela
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Carmen Mella
- Department of Internal Medicine, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Isabelle Quere
- Department of Vascular Medicine, Hôpital Saint Eloi, Montpellier, France
| | | | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Autónoma de Barcelona, Spain
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Karathanos C, Chatzis D, Latzios P, Papakostas I, Goumas K, Giannoukas AD. Treatment of superficial vein thrombosis with intermediate dose of tinzaparin: A real word cohort study - The SeVEN EXTension study. Phlebology 2021; 36:423-431. [PMID: 33407054 DOI: 10.1177/0268355520947300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess the treatment of superficial vein thrombosis (SVT) with intermediate dose of tinzaparin in a setting of real world practice. METHODS Prospective observational study of consecutive patients treated by vascular physicians in the private sector with tinzaparin (131 IU/Kg) once daily. Treatment duration was at the treating physician's discretion. The outcomes of the study were symptomatic venous thromboembolism, extension of thrombus and bleeding complications. RESULTS 660 patients were included and followed up for at least 3 months. Median duration of treatment was 30 days (14-120). History of prior deep vein thrombosis (HR 2.77; 95% CI= 1.18-6.49; p = 0.018) and current SVT above the knee (HR1.84; 95% CI = 1.33-3.53; p = 0.0002) were associated with prolonged treatment duration. Primary efficacy outcomes occurred in 20 (3%) patients. The median time to the event was 24 (6-92) days and was not related to treatment duration. CONCLUSIONS Tinzaparin at intermediate dose is an effective and safe treatment for SVT.
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Affiliation(s)
- Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Chatzis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Panagiotis Latzios
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Papakostas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Goumas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Sevestre MA, Soudet S. Epidemiology and risk factors for cancer-associated thrombosis. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:6S3-6S7. [PMID: 33276941 DOI: 10.1016/s2542-4513(20)30513-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer associated thrombosis (CAT) has been demonstrated a long time ago and is a frequent comorbid condition. Some risk factors are well established and related to the treatment of cancer: surgery, chemotherapy, radiation therapy, indwelling catheters. Other risk factors depend on tumour type and patient presentation, in particular pancreatic and brain cancer, bed resting and previous venous thrombosis. With the advances in cancer treatment and care, patients with cancer live longer and experience various therapies, sometimes during a long time. There is a need to better define the incidence and prevalence of CAT in the light of new therapeutic strategies and patient survival. This article focuses on the description of incidence and prevalence of CAT in the literature and on the description of risk factors, traditional but also emerging ones.
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Affiliation(s)
- M A Sevestre
- Service de médecine Vasculaire - EA 7516 Chimère UPJV, CHU Amiens, 80064 Amiens cedex.
| | - S Soudet
- Service de médecine Vasculaire - EA 7516 Chimère UPJV, CHU Amiens, 80064 Amiens cedex
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16
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Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA, Ten Cate-Hoek AJ, Elalamy I, Enzmann FK, Geroulakos G, Gottsäter A, Hunt BJ, Mansilha A, Nicolaides AN, Sandset PM, Stansby G, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Chakfé N, Hinchliffe R, Kolh P, Koncar I, Lindholt JS, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, De Maeseneer MG, Comerota AJ, Gloviczki P, Kruip MJHA, Monreal M, Prandoni P, Vega de Ceniga M. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg 2020; 61:9-82. [PMID: 33334670 DOI: 10.1016/j.ejvs.2020.09.023] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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Wahl U, Hirsch T. The importance of antiphospholipid syndrome testing in venous thromboembolism after varicose vein surgery. J Vasc Surg Venous Lymphat Disord 2020; 8:1097-1101. [PMID: 32381473 DOI: 10.1016/j.jvsv.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Anticoagulation treatment after a venous thromboembolism event is usually managed on a case-by-case basis. The risk of thrombosis must be weighed against the risk of bleeding. Identifying patients who could benefit from anticoagulation therapy requires the thromboembolism event to be assessed with respect to its presentation and the severity of the triggering factors. A case report is employed to explain the important aspects of practical approaches to venous thromboembolism events after vein surgery. The Trial on Rivaroxaban in AntiPhospholipid Syndrome (TRAPS) study has prompted new considerations for anticoagulation management. Patients with antiphospholipid syndrome need to be identified early to lower the risk of thromboembolism also during anticoagulation treatment.
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Affiliation(s)
- Uwe Wahl
- Department of Internal Medicine, BG Hospital Bergmannstrost Halle, Halle, Germany.
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competence Centre Halle, Halle, Germany
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18
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de Almeida MJ, Guillaumon AT, Miquelin D, Joviliano EE, Hafner L, Sobreira ML, Geiger MA, Moura R, Raymundo S, Yoshida WB. Guidelines for superficial venous thrombosis. J Vasc Bras 2019; 18:e20180105. [PMID: 31807127 PMCID: PMC6880617 DOI: 10.1590/1677-5449.180105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
Superficial venous thrombosis (SVT) or superficial thrombophlebitis is characterized by thrombi within superficial veins, with partial involvement or occlusion of the lumen and inflammatory reaction along the course of the vein. Clinical diagnosis tends to be straightforward, but supplementary tests and examinations are needed to confirm thrombosis extension and possible thromboembolic complications. SVT can be associated with deep venous thrombosis in 6 to 40% of cases, with asymptomatic pulmonary embolism (PE) in 20 to 33%, and with symptomatic PE in 2 to 13%. Despite the morbidity and complications, there are currently no Brazilian guidelines for SVT. These guidelines cover the most important issues related to SVT definition, terminology, and etiology, and set out recommendations for diagnosis and treatment.
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Affiliation(s)
| | | | - Daniel Miquelin
- Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Ludvig Hafner
- Faculdade de Medicina de Marília – FAMEMA, Marília, SP, Brasil.
| | - Marcone Lima Sobreira
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
| | | | - Regina Moura
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
| | - Selma Raymundo
- Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, SP, Brasil.
| | - Winston Bonnetti Yoshida
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
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19
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Sevestre MA, Galanaud JP, Sanchez O. [What is the management of superficial venous thromboses?]. Rev Mal Respir 2019; 38 Suppl 1:e171-e174. [PMID: 31699456 DOI: 10.1016/j.rmr.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M-A Sevestre
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Département de médecine vasculaire, centre de référence des maladies vasculaires rares, EA2992, université de Montpellier, CHU Montpellier, hôpital Saint-Eloi, 34295 Montpellier cedex 5, France
| | - J P Galanaud
- Département de médecine vasculaire, centre de référence des maladies vasculaires rares, EA2992, université de Montpellier, CHU Montpellier, hôpital Saint-Eloi, 34295 Montpellier cedex 5, France; Department of medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - O Sanchez
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Service de pneumologie et soins intensifs, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Innovations thérapeutiques en hémostase, Inserm UMRS 1140, 75006 Paris, France.
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20
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Bertoletti L, Delluc A, Frappé P, Roy PM, Sanchez O. [What route of care to propose to patients suffering from pulmonary embolism ? Who to treat as an outpatient ?]. Rev Mal Respir 2019; 38 Suppl 1:e74-e85. [PMID: 31611027 DOI: 10.1016/j.rmr.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- L Bertoletti
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Inserm UMR 1059, Inserm CIC-1408, équipe dysfonction vasculaire et hémostase, service de médecine vasculaire et thérapeutique, université Jean-Monnet, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - A Delluc
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; EA 3878 GETBO, université de Bretagne occidentale, 29200 Brest, France
| | - P Frappé
- Inserm UMR 1059 Sainbiose DVH, Inserm CIC-EC 1408, département de médecine générale, université de Saint-Étienne, 42000 Saint-Étienne, France
| | - P-M Roy
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Département de médecine d'urgence, service de médecine vasculaire, CHU d'Angers, 49000 Angers, France; Institut Mitovasc, UMR 1083, UFR santé, université d'Angers, 49000 Angers, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service de pneumologie et de soins intensifs, université de Paris, AH-HP, Sorbonne Paris-Cité, hôpital Européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Innovations thérapeutiques en hémostase, Inserm UMRS 1140, 75006 Paris, France.
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21
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Premkumar P, Kalipatnapu S, Selvaraj D, Agarwal S. Superficial venous thrombosis: Single-center experience and current recommendations. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Galanaud JP, Blaise S, Sevestre MA, Terrisse H, Pernod G, Gaillard C, Genty C, Monreal M, Rabah Y, Kahn SR, Quéré I, Bosson JL. Long-term outcomes of isolated superficial vein thrombosis in patients with active cancer. Thromb Res 2018; 171:179-186. [DOI: 10.1016/j.thromres.2018.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 02/01/2023]
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23
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Nikolakopoulos KM, Kakkos SK, Papageorgopoulou CP, Tsolakis IA. Extended-Duration Treatment of Superficial Vein Thrombosis of the Lower Limbs with Tinzaparin. Vasc Specialist Int 2018; 34:1-9. [PMID: 29629359 PMCID: PMC5880338 DOI: 10.5758/vsi.2018.34.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To identify risk factors for recurrent thromboembolic events (RTEs) and define the optimum duration of treatment with tinzaparin in patients with superficial vein thrombosis (SVT) of the lower limbs. MATERIALS AND METHODS A total of 147 consecutive patients with significant SVT were treated with subcutaneously administered tinzaparin. The composite primary endpoint of the study was RTE, deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) at 120 days. Patients were stratified into group A, where patients received a variable dose of tinzaparin for up to 60 days (n=98), and a subsequent group B-ext, where patients received a standardized intermediate dose of tinzaparin (n=49) for 90 days. RESULTS RTEs occurred in 15/147 patients (10.2%), including recurrent SVT (n=10), DVT (n=4) and fatal PE (n=1). RTEs were less frequent in group B-ext (0% vs. 15.3% for group A, P=0.004), a difference that remained significant at the one-year follow-up. Clinically extensive SVT was an independent predictor for RTEs (hazard ratio, 5.94; 95% confidence interval, 2.05-17.23; P=0.001, Cox regression). Predictors or DVT or PE in group A included clinically extensive SVT (P=0.004), absence of local pain (P=0.023) and the ultrasound findings of superficial axial vein thrombosis (any, P=0.006 or isolated, P=0.036) and multiple thrombosed superficial venous sites (P<0.001). CONCLUSION An extended three-month regimen of tinzaparin in patients with SVT of the lower limbs is more effective than a shorter course and may be desirable in patients with risk factors.
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Affiliation(s)
| | - Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | - Ioannis A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
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24
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Giannoukas A, Karathanos C, Nikolakopoulos K, Georgiadis GS, Maltezos C, Ioannou C, Vasdekis S, Trelopoulos G. Tinzaparin in intermediate dose for the treatment of superficial vein thrombosis: Results from an observational multicenter study—SeVEN study. Phlebology 2017; 33:636-645. [DOI: 10.1177/0268355517748540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives Low-molecular-weight heparins are recommended in the treatment of superficial vein thrombosis but with low grade of evidence. This study was conducted to assess the treatment outcomes of acute superficial vein thrombosis with intermediate dose of Tinzaparin. Methods Retrospective analysis of records from outpatients over a period of 16 months treated in seven centers with Tinzaparin 0.5 ml (10,000 anti-Xa IU) once daily for a period that was at the treating physician’s discretion. All the patients were followed up for at least 12 weeks. Results A total of 296 patients (189 females, mean age 57.4 years) were included. Two thirds of the patients (191/296, 64.5%) received treatment for approximately five weeks (mean 36.9 days) and the remaining (105/296, 35.5%) for a shorter period (mean 16.2 days). There was no difference in patients’ characteristics between the two treatment duration groups. The presence of thrombus above the knee and restricted daily activity were associated with longer period of treatment. Only one case with minor bleeding was observed. Recurrence of thrombosis over a 12-week follow-up period occurred in 6% (superficial vein thrombosis in 14 (4.7%), deep vein thrombosis in 3 (1%) and thrombus extension in the superficial veins in 1 (0.3%)). Recurrence was not related to the duration of treatment. Conclusions Intermediate dose of Tinzaparin was an effective and safe treatment for superficial vein thrombosis in the setting of real world practice. Location of thrombus and status of patients’ mobilization were associated with longer duration of treatment. Future prospective randomized studies are needed to corroborate these findings.
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Affiliation(s)
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece
| | | | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Christos Ioannou
- Department of Vascular Surgery, University Hospital of Heraklion, Crete, Greece
| | - Spyros Vasdekis
- Department of Vascular Surgery, “ATTIKON” University Hospital, Athens, Greece
| | - Georgios Trelopoulos
- Vascular Surgery Unit, Department of Cardio-Thoracic Surgery, “Papanikolaou” Hospital, Thessaloniki, Greece
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25
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Beyer-Westendorf J. Controversies in venous thromboembolism: to treat or not to treat superficial vein thrombosis. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:223-230. [PMID: 29222259 PMCID: PMC6142594 DOI: 10.1182/asheducation-2017.1.223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The management of superficial vein thrombosis (SVT) is poorly defined and remains controversial overall. SVT has long been considered a benign, self-limited disease, but recent studies show that SVT carries a nonnegligible risk for recurrence, deep vein thrombosis, or pulmonary embolism. Current guidelines recommend the use of low-molecular-weight heparin or fondaparinux, but results of several surveys indicate that the majority of patients with SVT receive nonanticoagulant therapy only, which includes compression stockings or bandages, nonsteroidal anti-inflammatory drugs, topical application of heparin gel, or surgical interventions. However, several recent observational and interventional studies provide better insight into the optimal treatment of patients with SVT who are at different risks for thromboembolic complications. This educational review summarizes the available evidence and aims to provide practical guidance based on a clinical decision pathway.
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Affiliation(s)
- Jan Beyer-Westendorf
- Thrombosis Research Unit, Division of Hematology, Department of Medicine I, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany; and King's Thrombosis Service, Department of Hematology, King's College London, London, United Kingdom
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26
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Barco S, Pomero F, Di Minno MND, Tamborini Permunian E, Malato A, Pasca S, Barillari G, Fenoglio L, Siragusa S, Di Minno G, Ageno W, Dentali F. Clinical course of patients with symptomatic isolated superficial vein thrombosis: the ICARO follow-up study. J Thromb Haemost 2017; 15:2176-2183. [PMID: 28871623 DOI: 10.1111/jth.13840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/28/2022]
Abstract
Essentials Late sequelae of isolated superficial vein thrombosis (iSVT) have rarely been investigated. We studied 411 consecutive outpatients with acute iSVT with a median follow-up of three years. Male sex and cancer are risk factors for future deep vein thrombosis or pulmonary embolism. Patients without cancer appear to be at a negligible risk for death. SUMMARY Background Studies of long-term thromboembolic complications and death following acute isolated superficial vein thrombosis (iSVT) of the lower extremities are scarce. Objectives To investigate the course of iSVT in the setting of an observational multicenter study. Methods We collected longitudinal data of 411 consecutive outpatients with acute, symptomatic, objectively diagnosed iSVT who were previously included in the cross-sectional ICARO study. Four patients followed for < 30 days and 79 with concomitant deep vein thrombosis (DVT) or pulmonary embolism (PE) were excluded from the present analysis. The primary outcome was symptomatic DVT or PE. The safety outcomes were major bleeding and all-cause death. Results The median follow-up time was 1026 days (interquartile range 610-1796). Symptomatic DVT/PE occurred in 52 (12.9%) patients, giving annualized rates of 1.3% (95% confidence interval [CI] 0.3-3.9%) on anticoagulant treatment and 4.4% (95% CI 3.2-5.8%) off anticoagulant treatment. Male sex (adjusted hazard ratio [HR] 2.03 [95% CI 1.16-3.54]) and active solid cancer (adjusted HR 3.14 [95% CI 1.11-8.93]) were associated with future DVT/PE, whereas prior DVT/PE failed to show significance, most likely because of bias resulting from prolonged anticoagulant treatment. Three major bleeding events occurred on treatment, giving an annualized rate of 1.4% (95 CI 0.3-4.0%). Death was recorded in 16 patients (annualized rate: 1.1% [95% CI 0.6-1.7%]), and was attributable to cancer (n = 8), PE (n = 1), cardiovascular events (n = 3), or other causes (n = 4). Conclusions The long-term risk of DVT/PE after anticoagulant discontinuation for acute iSVT is clinically relevant, especially in males and in the presence of active cancer. The risk of death appears to be negligible in patients without cancer.
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Affiliation(s)
- S Barco
- Center for Thrombosis and Hemostasis, University Medical Hospital of the Johannes Gutenberg University, Mainz, Germany
| | - F Pomero
- Department of Clinical Medicine, ASO S. Croce e Carle, Cuneo, Italy
| | - M N D Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - A Malato
- Hematology Unit, University of Palermo, Palermo, Italy
| | - S Pasca
- Center for Hemorrhagic and Thrombotic Diseases, University Hospital of Udine, Udine, Italy
| | - G Barillari
- Center for Hemorrhagic and Thrombotic Diseases, University Hospital of Udine, Udine, Italy
| | - L Fenoglio
- Department of Clinical Medicine, ASO S. Croce e Carle, Cuneo, Italy
| | - S Siragusa
- Hematology Unit, University of Palermo, Palermo, Italy
| | - G Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - W Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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