Tag Archives: Anticoagulants

Portal Vein Thrombosis After Venous Reconstruction During Pancreatectomy

Posted on by
Reply

“Due to the close anatomical relationship between the superior mesenteric vein/portal vein (SMV/PV) and the posterior neck of the pancreas, venous involvement by tumor or
inflammation occurs frequently. SMV/PV involvement was historically considered a sign of advanced pancreatic cancer; however, surgeons, seeking to expand the number of
patients who could benefit from pancreatectomy for cancer, introduced en bloc venous resection. An early pioneer in this work was Fortner who in 1984 described the concept
of regional pancreatectomy with vascular resection in 35 patients. This procedure encountered high mortality (26%) and morbidity that nullified any potential survival benefit.
Over the past three decades, SMV/PV resection during pancreatectomy has grown in frequency as improved surgical outcomes were observed after careful preoperative planning
with the aid of enhanced radiographic imaging. As indications for venous resection during pancreatectomy were refined, observational studies validated the safety of SMV/PV resection.”

Continue reading →

Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism

Posted on by
Reply

“Direct oral anticoagulants, including rivaroxaban and apixaban, are the most frequently prescribed treatments for acute venous thromboembolism. In randomized clinical trials, rivaroxaban at a dose of 15 mg twice daily for 21 days followed by 20 mg daily and apixaban at a dose of 10 mg twice daily for 7 days followed by 5 mg twice daily were noninferior to vitamin K antagonists regarding efficacy (risk of recurrent venous thromboembolism). These trials showed that clinically relevant bleeding, a composite of major bleeding or clinically relevant nonmajor bleeding, occurred in 4.3% of the patients who received apixaban as
compared with 9.7% of those who received vitamin K antagonists9 and in 8.1% of patients who received rivaroxaban as compared with 8.1% of those who received vitamin K antagonists. The difference between apixaban and rivaroxaban therapy regarding the risk of clinically relevant bleeding was hypothesized to be related to heterogeneity in the patient populations and differences in the trial designs. Owing to a lack of trials that have compared rivaroxaban with apixaban regarding the risk of bleeding, clinical practice guidelines do not recommend one anticoagulant over the other.”

Continue reading →

Anticoagulant treatment for upper extremity deep vein thrombosis

Posted on by
Reply

“Upper extremity DVT may be complicated by recurrent thrombosis in about 7.5% of cases and by post-thrombotic syndrome in 19.4% of cases, with higher rates of recurrence in patients with cancer-associated thrombosis and of post-thrombotic syndrome in patients with unprovoked thrombosis or related to congenital or anatomical abnormalities. The intensity and duration of anticoagulant treatment need to be balanced against the risk of bleeding
complications, especially in high-risk subgroups like patients with cancer in whom major bleeding events were reported in up to 10%.”

FIGURE 2 Recurrent venous thromboembolism and major bleeding in patients with upper extremity deep vein thrombosis, sorted by the proportion of patients with cancer and an indwelling catheter. Recurrent venous thromboembolism and major bleeding occurring during anticoagulant treatment were considered in the analysis. The vertical line indicates the summary estimate. Gray squares indicate individual study estimates of the proportion, whereas the gray horizontal lines indicate 95% confidence intervals of the individual studies. The diamond indicates the summary estimate with 95% confidence intervals. The horizontal black line refers to the prediction intervals which are displayed numerically under the 95% confidence intervals. CI, confidence interval; ES, estimates; PI, prediction interval
Continue reading →

Management of Patients With Acute Lower Gastrointestinal Bleeding

Posted on by
Reply

“Acute lower gastrointestinal bleeding (LGIB) is one of the most common reasons for hospitalization in the United States due to a digestive disorder, accounting for over 100,000 admissions annually. Although historically LGIB has referred to a bleeding source originating distal to the ligament of Treitz, small bowel bleeding is considered a separate entity, with a distinct diagnostic and therapeutic algorithm. For the purposes of this clinical practice guideline, LGIB refers to hematochezia or bright red blood per rectum originating from a colorectal source.”

Continue reading →

Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries

Posted on by
Reply

“General surgical patients who undergo major operations are at risk of venous thromboembolism (VTE). This incurs significant morbidity and healthcare costs. Therefore, the Royal Australasian College of Surgeons and other regulatory bodies recommend routine thromboprophylaxis. Moreover, considerations for thromboprophylaxis is an integral part of theatre timeout performed prior to any operation.”

“In this study, we extend the observations made from our multicentre survey by quantifying the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and placing them in context of their bleeding and VTE risk. Findings from this study will highlight areas of practice with the greatest variability, allow surgeons to benchmark their practices against that of their colleagues and focus future research to optimize perioperative thromboprophylaxis.”

Continue reading →

Anticoagulant bridging in left-sided mechanical heart valve patients

Posted on by
Reply

“There are two strategies for heparin bridging; administration of intravenous unfractionated heparin (UFH), and subcutaneous low-molecular-weight heparin (LMWH). While both strategies reduce the risk of valve thrombus formation, they have distinct biomedical, financial, and logistical profiles. UFH is administered intravenously according to a nomogram and hence requires peri-procedural hospital admission and continuous monitoring of
activated partial thromboplastin time (aPTT). In contrast, LMWH is administered subcutaneously once or twice daily in an outpatient setting and usually does not require continuous blood monitoring of anti-Xa levels.”

Continue reading →

Management of antithrombotic therapy in patients undergoing invasive procedures

Posted on by
Reply

“The question of whether antithrombotic therapy should be suspended in a patient who
will be undergoing an invasive procedure involves balancing the risk of postproce-
dural bleeding with continued treatment against the thrombotic risk with suspension
of treatment and use of bridging anticoagulation therapy. In general, a patient under-
going a procedure that is associated with a low risk of bleeding (low-risk procedure)
can safely continue antithrombotic therapy and should do so, particularly if the pa-
tient is at high risk for a thromboembolic event (high-risk patient). Conversely, a pa-
tient undergoing a high-risk procedure can temporarily discontinue antithrombotic
agents safely if the patient is at low risk for a thromboembolic event (low-risk patient).”

Continue reading →