Therapy For Venous Thrombosis Research Articles

Management of Deep Vein Thrombosis: An Update Based on the Revised AWMF S2k Guideline.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of venous thromboembolism (VTE). Most DVTs affect the lower-extremity veins. Since the symptoms of DVT are non-specific, a prompt and standardised diagnostic work-up is essential to minimise the risk of PE in the acute phase and to prevent thrombosis progression, post-thrombotic syndrome and VTE recurrence in the long-term. Only recently, the AWMF S2k guidelines on Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism have been revised. In the present article, we summarize current evidence and guideline recommendations focusing on lower-extremity DVT (LEDVT). Depending on whether the diagnostic work-up is performed by a specialist in vascular medicine or by a primary care physician, different diagnostic algorithms are presented that combine clinical probability, D-dimer testing and diagnostic imaging. The diagnosis of ipsilateral recurrent DVT poses a particular challenge and is presented in a separate algorithm. Anticoagulant therapy is an essential part of therapy, with current guidelines clearly favouring regimens based on direct oral anticoagulants over the traditional sequential therapy of parenteral anticoagulants and vitamin K antagonists. For most DVTs, a duration of therapeutic-dose anticoagulation of at least 3 to 6 months is considered sufficient, and this raises the question of the risk of VTE recurrence after discontinuation of anticoagulation and the need for secondary prophylaxis in the long-term. Depending on the circumstances and trigger factors that have contributed to the occurrence of DVT, management strategies are presented that allow decision-making taking into account the individual bleeding risk and patient's preferences.

Recurrent Venous Thromboembolism in Patients on Anticoagulation: An Update Based on the Revised AWMF S2k Guideline.

In the recently updated German S2k Guideline "Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism," a new chapter was incorporated about recurrent venous thromboembolism (VTE) in patients on anticoagulation treatment. Despite the high efficacy of anticoagulation in most patients, approximately 2% experience a recurrent VTE event while receiving anticoagulant drugs. The proper diagnosis of the recurrent VTE is important and possible only with the knowledge of localization and thrombus burden of the primary VTE event. Possible reasons for recurrent VTE events in patients on anticoagulation are non-adherence to medication, sub-therapeutic drug levels due to resorption disorders or drug interactions, or concomitant disease with high thrombogenicity. Cancer is the most common underlying disease, but it is important to investigate and understand possible other causes whenever a breakthrough VTE event occurs. This results in the recommendation that in patients with VTE recurrence on therapeutic anticoagulation, in particular, the presence of malignant disease, antiphospholipid syndrome, and rare diseases like paroxysmal nocturnal hemoglobinuria or Behçet's disease should be considered. For VTE recurrence during heparin therapy, heparin-induced thrombocytopenia type II needs to be ruled out, even if platelet counts are within the normal range. Although the mechanisms of recurrence on anticoagulation can be evaluated in a certain degree, clinical evidence for the management of recurrent VTE in anticoagulated patients is minimal and mainly based on expert opinion. Switching anticoagulant medication and intensifying anticoagulant treatment are possible options.

Current Topics from the Revised German S2k Guideline on Diagnosis and Treatment of Venous Thromboembolism.

It is an honor and a great pleasure for us to be guest editors for this special issue of Hämostaseologie - Progress in Haemostasis, which addresses important issues surrounding the complex of venous thromboembolism (VTE). In February 2023, the revised guideline on "Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism" has been published on the website of the Association of the Scientific Medical Societies in Germany (AWMF)1. This guideline was drawn up under the leadership of the German Society of Angiology (DGA), and representatives of 17 scientific societies contributed to its content. As an S2k guideline, its recommendations are consensus based and are the result of a systematic review and evaluation of current evidence and consideration of the benefits and harms of diagnostic and therapeutic options. In this special issue, guideline authors provide a comprehensive overview of selected guideline topics which might be of clinical relevance to our readers and our community of haemostaseologists.

Cancer-Associated Venous Thromboembolism-Diagnostic and Therapeutic Considerations: An Update Based on the Revised AWMF S2k Guideline.

Patients with cancer are prone to develop venous thromboembolism (VTE) with negative impact on quality of life, morbidity, and mortality. Treatment of established VTE is often complex in patients with cancer. Treatment of cancer-associated VTE (CAT) basically comprises initial and maintenance treatment, for 3 to 6 months, secondary preventions, and treatment in special situations. Therapeutic anticoagulation is the treatment of choice in CAT. In addition to the efficacy and safety of low-molecular-weight heparin (LMWH) that had been recommended for decades, direct oral anti-factor Xa inhibitors, a subgroup of direct oral anticoagulants (DOACs), demonstrated their advantages along with the accompanying concerns in several randomized controlled treatment trials of CAT. The latest guidelines, such as the German AWMF-S2k Guideline "Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism," agree with each other on most aspects with respect to the treatment of CAT. Encompassing recent clinical studies, and meta-analyses, as well as the focus on some special management aspects of CAT, the objective of this review is to present a current overview and recommendations for the treatment of CAT.

Ten key messages of the S2kguideline on diagnostics and therapy of venous thrombosis and pulmonary embolism

Ten key messages of the S2kguideline on diagnostics and therapy of venous thrombosis and pulmonary embolism

The Role of Platelets in Venous Thromboembolism.

Multiple factors contribute to the risk of venous thromboembolism (VTE). Platelets have attracted much interest in arterial cardiovascular disease, whereas their role in VTE has received much less attention. Recent evidence suggests that platelets may play a more important role in VTE than previously anticipated. This review discusses the mechanisms that link platelets with venous thrombotic disease and their potential applications as novel risk factors for VTE. In addition, animal studies and randomized clinical trials that highlight the potential effect of antiplatelet therapy in venous thrombosis are evaluated to assess the role of platelets in VTE. The clinical significance of platelets for VTE risk assessment in specific patient cohorts and their role as a suitable therapeutic target for VTE prevention is acknowledged. The role of platelets in VTE is a promising field for future research.

Ultrasound dynamics lysis apex thrombus as an objective criterion of effectiveness of anticoagulation therapy in venous thrombosis

To assess the effectiveness of anticoagulant therapy (ACT) for the treatment of patients with deep venous thrombosis (DVT) of the lower extremities. The study considered ultrasonic characteristics of lysis of the proximal part of thrombus: localization and nature of venous thrombosis, the length and diameter of the proximal floating part of the thrombus, and duration of the venous thrombosis. Depending on the ACT options patients were divided into 3 groups: Group 1 (18 patients) received rivaroxaban, group 2 (19 patients) received enoxaparin sodium with subsequent transition to warfarin, and 3 group (19 patietns) received enoxaparin sodium, followed by administration of rivaroxaban. Treatment with rivaroxaban was preferable over standard ACT with enoxaparin/warfarin with regards to the lysis of thrombus when duration of thrombosis did not exceed 10 days. In 10.5% of patients who received warfarin flotation of thrombi remained for 14 days; the length of the floating part of the thrombi did not exceed 3 cm. Such circumstances and inability to reach a therapeutic INR value required cava filter placement. Treatment with enoxaparin sodium followed by the administration of rivaroxaban was found to be the most efficient ACT regimen as there was no negative dynamics of ultrasound characteristics of lysis of thrombi at any duration of the disease.

Оценка эффективности и безопасности различных вариантов антикоагулянтной терапии при венозных тромбозах

Оценка эффективности и безопасности различных вариантов антикоагулянтной терапии при венозных тромбозах

Microparticles as a Strategy for Low-Molecular-Weight Heparin Delivery

The aims of this work were preparation and physical-chemical characterization of a microparticulate release system for delivery of enoxaparin sodium (ENX), a low-molecular-weight heparin, as a potential vehicle for optimization of deep venous thrombosis therapy. Microparticles (MPs) containing ENX were prepared from polylactide-co-glycolic acid [PLGA; (50:50)] by a double emulsification/solvent evaporation method. The preparation parameters, such as proportion ENX/PLGA, surfactant concentration, type, time, and speed of stirring, were evaluated. The encapsulation efficiency and yield process were determined and optimized, and the in vitro release profile was analysed at 35 days. The MPs showed a spherical shape with smooth and regular surfaces. The size distribution showed a unimodal profile with an average size of 2.0 ± 0.9 μ m. The low encapsulation efficiency (<30%), characteristic of hydrophilic macromolecules was improved, reaching 50.2% with a procedure yield of 71.3%. The in vitro profile of ENX release from the MPs was evaluated and showed pseudo-zero-order kinetics. This indicated that diffusion was the main drug release mechanism.

Inferior vena cava filters do not appear to provide any additional benefit in patients undergoing anticoagulation therapy for venous thrombosis,

Inferior vena cava filters do not appear to provide any additional benefit in patients undergoing anticoagulation therapy for venous thrombosis,

New developments in the thrombolytic therapy of venous thrombosis

Thrombolysis in deep venous thrombosis is indicated in acute thrombosis of the legs, because in most cases it is due to no or to minimal collateral flow with bad prognosis. Thrombolysis should not be used regularly in isolated thrombosis of the veins of the lower legs and in subclavia vein thrombosis. The aims in therapy of deep venous thrombosis are (1) reduction of fatal pulmonary embolism, (2) avoidance of progression and recurrence, and (3) avoidance of a postthrombotic syndrome. In contrast to heparin alone, thrombolysis has the advantage of high recanalization rates. With clinically used dosage regimens of streptokinase complete and partial recanalization rates are in the range of 60–70 % of primary occluded veins. According to pilotai and dose-finding studies, the results with rt-PA are in the same range. In a different approach, the thrombolytic substances are delivered in a locoregional type via a vein of the foot. There is some evidence from pilotai clinical trials that the comparable response rates are obtainable as with streptokinase in ultrahigh dosage combined with a lower incidence of bleeding complications and pulmonary embolism. Furthermore there is a need for prospective, randomized trials comparing therapy with rt-PA and heparins, especially low molecular heparin.

Therapy for venous thrombosis: guidelines for a competent and cost-effective approach.

Therapy for venous thrombosis: guidelines for a competent and cost-effective approach.

Heparin therapy in venous thrombosis

DVT has been reported to occur in up to 42% of trauma patients. Complications of DVT can include PE, which may lead to death. DVT treatment can be accomplished pharmacologically with UH, LMWH, and thrombolytics. Thrombolytics have a high adverse event profile and are contraindicated in many patients, which limits their usefulness in practice. UH is widely used for its favorable adverse effect profile with careful monitoring of the APTT, ease of rapid anticoagulation by using one of several heparin-dosing nomograms, and proven track record in the prevention of DVT extension and recurrence. Drawbacks of UH include frequent changes in dosing while titrating anticoagulant effect, frequent laboratory monitoring of the APTT, and increased risk of bleeding. In the future the use of LMWH may increase to treat DVT because of fixed-dose administration, once or twice daily dosing, and lack of laboratory monitoring. Studies have shown a reduced risk of major bleeding and a decreased recurrence of DVT when LMWHs are compared with UH. Further studies are needed to determine whether LMWH will become the mainstay of treatment for DVT.

Short- or long-term oral anticoagulant therapy for venous thrombosis?

Short- or long-term oral anticoagulant therapy for venous thrombosis?

Thrombolytic therapy in venous thrombosis and pulmonary embolism

Antithrombotic therapy in the management of venous thromboembolism is mandatory in most instances, since in untreated patients the frequency of major morbidity and mortality from extension or recurrence is high. In the acute phase, approximately 50% of venous thrombosis patients who do not receive anticoagulants will develop recurrent thrombosis. In addition, pulmonary embolism occurs in 30% of untreated patients which may be fatal in about 5% of patients.‘.*,” Late complications of deep vein thrombosis including recurring pain and swelling of the legs occasionally complicated by persistent or recurrent venous ulceration, are common. Recurrent pain and swelling, known as the postphlebitic syndrome or chronic venous insufficiency, occurs in up to 70% of patients with proximal vein thrombosis even after adequate initial treatment.4.5.6 In a recent descriptive study of 341 consecutive patients with deep vein thrombosis who were followed for 5.5 years, the frequency of venous ulceration was found to be 6.7%.7 The mortality from recurrent pulmonary embolism in untreated patients who have survived the initial episode has been estimated to be between 20% and 70%.’ The frequency of diminished respiratory reserve in patients who survive major pulmonary embolism is unknown but chronic thromboembolic pulmonary hypertension, although relatively uncommon, is increasingly being recognized as an important and serious complication of patients with major or recurrent pulmonary embolism.8

The Potential Role of Thrombolytic Therapy in Venous Thrombosis

Anticoagulant therapy for lower extremity deep-vein thrombosis (DVT) has been shown to reduce mortality from pulmonary embolism, but subsequent morbidity from the postthrombotic syndrome remains high. Thrombolytic therapy produces higher lysis rates of venous thrombi than heparin alone. Some studies suggest a lower incidence of postthrombotic sequelae after early use of streptokinase. These potential benefits are limited to those patients without contraindications for this therapy. For the past 3 years we have prospectively studied patients with DVT documented by duplex scanning. The records of these patients were reviewed to determine what proportion of this population would have been candidates for thrombolytic therapy. For this analysis, contraindications to the use of thrombolytic agents included: (1) recent surgery (less than 1 month); (2) recent major trauma; (3) active or recent bleeding; (4) brain disease (cerebrovascular accident, brain tumor, arteriovenous malformation); (5) pregnancy; and (6) bleeding diathesis. Also, patients with prior ipsilateral DVT and those with acute symptoms present for 7 or more days were not considered to be candidates for thrombolytic therapy. A contraindication to thrombolytic therapy was present in 194 (93%) of 209 patients with a diagnosis of DVT, including four patients with a relative contraindication. Two or more contraindications were present in 65 cases (31%). Recent surgery was the most frequent factor precluding therapy, being present in 71 patients. A history of DVT in the affected leg was present in 45 patients. Only 15 (7%) of 209 patients with DVT exhibited no contraindications for thrombolytic treatment. Only a small fraction of patients with venous thrombosis will be potential candidates for this therapy.

The potential role of thrombolytic therapy in venous thrombosis

The potential role of thrombolytic therapy in venous thrombosis

Basic data related to thrombolytic therapy for venous thrombosis.

Basic data related to thrombolytic therapy for venous thrombosis.

Comparison of Long Term Anticoagulant Therapy in Venous Thrombosis

Comparison of Long Term Anticoagulant Therapy in Venous Thrombosis