Treatment Of Venous Thromboembolic Complications Research Articles

Prevention and treatment of venous thromboembolic complications in orthopedic patients

To analyze the comprehensive program for prevention of thromboembolic complications in orthopedic patients. We have analyzed thromboembolic complications in orthopedic patients after surgeries on large joints over the past 5 years (2018-2022). A comprehensive approach to prevention and treatment of thromboembolic complications including ultrasound, early surgical prevention of pulmonary embolism can significantly improve postoperative outcomes after joint replacement surgery. Vacuum aspiration retrograde thrombectomy is effective, feasible and safe for acute ilio-femoral venous thrombosis reducing hospital-stay (p=0.0124) and restoring vein patency. Widespread thromboembolic complications, especially for pulmonary embolism in 2022, are likely due to a new coronavirus infection and require careful screening of patients with risk factors with appropriate preventive antithrombotic therapy.

The possibilities of the thrombodynamics test in predicting, diagnosing and monitoring the effectiveness of the treatment of venous thromboembolic complications in planned surgical interventions

Introduction. The problem of venous thromboembolic complications after planned surgical interventions remains relevant and requires special research and analysis, which was the purpose of this work. Objective. To study and evaluate the possibilities of the thrombodynamics test for predicting, diagnosing, and monitoring the effectiveness of treatment of postoperative venous thromboembolic complications in planned surgical interventions. Materials and methods. In this study, we implemented the thrombodynamics test in parallel with ultrasound examination of the veins of the lower extremities and pelvis before planned surgery and in the postoperative period on 1–3, 7–9, 14–16, and 30 days in 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias, and varicose veins of the lower extremities) stratified into risk groups for postoperative venous thromboembolic complications. Results. It was revealed that, in the preoperative period, 16.6 % of patients have hypercoagulation at normal standard blood counts and 65 % of them are patients from a low-risk group of venous thromboembolic complications. In the postoperative period, the number of cases of hypercoagulation increased to 34.2 % due to elderly and senile patients from groups with an estimated moderate and high risk of venous thromboembolic complications. Deep vein thrombosis was detected in 18 (15 %) subjects (6 patients from each risk group) within 2–15 days after surgery and in all cases it developed in the presence of preoperative hypercoagulation. Conclusions. It is shown that the thrombodynamics test is highly informative in predicting, diagnosing and evaluating the effectiveness of venous thromboembolic complications treatment during planned surgical interventions.

ОСОБЕННОСТИ ПОЖИЛЫХ ПАЦИЕНТОВ: КАК ИХ УЧИТЫВАТЬ ПРИ НАЗНАЧЕНИИ АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ?!

Malfunctions in the functioning of the blood coagulation system are often found in elderly patients. Age and the presence of concomitant diseases are not only risk factors for thrombosis, but also increase the likelihood of bleeding. This significantly complicates the problem of choosing anticoagulant therapy. Thus, chronic heart failure, chronic obstructive pulmonary disease, diabetes mellitus, cancer, etc. are established prothrombotic risk factors. Acquired hemophilia and von Willebrand syndrome, factor XI or vitamin K deficiency, thrombocytopenia and thrombocytopathy, on the contrary, may be risk factors for bleeding. Additional difficulties in prescribing anticoagulant therapy to elderly patients arise due to common problems in old age: renal failure, impaired liver function, polypharmacy, etc. However, the presence of these features is not a reason to refuse anticoagulant therapy, since the risk of thrombosis in such patients, as a rule, exceeds the risk of bleeding. This review details the problems that a clinician may face when prescribing anticoagulant therapy to elderly patients and provides recommendations for overcoming them. It is also reported that in the absence of contraindications, direct oral anticoagulants are the best option for the treatment of venous thromboembolic complications.

Выбор метода профилактики тромботических осложнений у пациентов с хирургическими заболеваниями желудка высокого риска

INTRODUCTION: Despite the significant advances in the prevention and treatment of venous thromboembolic complications (VTEC), pulmonary embolism (PE) remains the most common preventable cause of hospital postoperative mortality. One of the causes of thrombosis is surgical operations, especially laparoscopic, associated with the activation of the hemostasis system. Aim: The choice of a prevention method of thrombotic complications in comorbid patients with signs of varicose veins of the lower extremities requiring laparoscopic surgical treatment of benign gastric diseases (BGD). MATERIALS AND METHODS: The study is based on a treatment analysis of 128 patients with BGD in combination with a high comorbid background. The treatment of these patients was divided into several stages, which included both vascular interventions for the prevention of VTEC and a laparoscopic stage aimed at treating the underlying disease. The patients were divided into 3 groups comparable in gender and age. The first group, consisting of 45 people, VTEC prevention was carried out using a standard conservative technique (anticoagulant therapy in combination with mechanical prophylaxis). The second group included 43 patients who underwent both standard conservative therapy and open surgery aimed at correcting venous insufficiency in the great saphenous vein system. The third group is represented by 40 patients who, in addition to the standard conservative prevention of VTEC, underwent a combined surgical treatment (crossectomy and endovenous laser coagulation (EVLC) of the trunk of the great saphenous vein by retrograde method). All patients underwent coagulogram analysis and ultrasound triplex scanning of the veins of the lower extremities at each stage of the treatment. RESULTS: In the first group of patients, the largest number of thrombotic complications was noted — 24.4%, in the second group their number was 14%, while in the third group, thrombotic complications were detected in only 7.5% of patients. In the second and third groups, there was no development of PE, both after the first operation and after the main laparoscopic stage of treatment. In the first group, on the contrary, 2 episodes of PE (4.4%) were noted after the main surgical treatment. In turn, the standard anticoagulant therapy carried out in all three groups led to the development of both small and large hemorrhagic complications. At the same time, it should be noted that their frequency was comparable in all three groups, and their number did not exceed the number of such complications based on literature data. CONCLUSION: Carrying out active operative prevention of thrombotic complications significantly reduces their frequency in comorbid patients with signs of varicose veins of the lower extremities, thereby allowing to improve the result of the treatment. Considering that laparoscopic surgical interventions on the stomach increase the risk of developing VTEC in comorbid patients, according to our data, performing EVLC in combination with crossectomy, as the first stage of prophylaxis, prevents the development of PE and reduces the risk of venous thrombotic complications by 16.9%.

Modern approaches to the prevention of venous thromboembolic complications in patients with active cancer

Cancer is one of the most significant risk factors for venous thromboembolic complications (VTEC), which combines deep vein thrombosis and pulmonary embolism. Of the many well-known risk factors for VTEC, only cancer is associated with a 4-fold increased risk of venous thrombosis, and in cancer patients receiving chemotherapy the risk increases by up to 6.5-fold. Venous thrombosis is increasingly common in cancer patients and contributes significantly to the course of the underlying disease and mortality, especially when combined with additional risk factors, the most significant of which are surgery and chemotherapy treatment. The prevention and treatment of VTEC in cancer patients is a challenge, primarily due to the pathogenesis of cancer-associated thrombosis, the presence of additional risk factors associated with cancer, the high risk of haemorrhagic complications, reduced renal function and the recurrent nature of VTEC. Aspects of safe prevention remain an integral part of the management of patients with active cancer. The most vulnerable periods for the development of VTEC are the periods when the patient is hospitalised for surgical or therapeutic treatment and the long period of chemotherapy treatment on an outpatient basis. A comprehensive approach to the prevention of VTEC in patients with cancer should primarily involve careful selection of high-risk patients at each stage of treatment of the malignancy; these patients are the ones who will benefit most from drug thromboprophylaxis. The treatment of an already confirmed VTEC in a cancer patient always involves the additional challenges of drug interactions and increased haemorrhagic risk due to prolonged use of treatment doses of anticoagulants, which may in turn affect the effectiveness of chemotherapy or the efficiency and safety of anticoagulant therapy.

Venous thromboembolitic complications in children and adults with permanent venous access (literature review)

Introduction. Over the past decades, permanent venous access devices, in particular port systems and peripherally implanted central catheters, has been increasingly introduced in adult and pediatric oncology. As far as central catheters and permanent access devices are foreign bodies in basic veins, quite naturally that they are one more risk factor for thrombosis.Material and methods. The authors searched literature data ( in Russian and English) for the period up to May 3, 2022 using public databases (Embase, Medline/PubMed, Researchgate, medrxiv.org, RSCI/eLibrary). The following keywords were used for the search: “port-system”, “peripherally implanted central catheter”, “totally implanted vascular access device”, “venous thromboembolism”, “VTE”, “venous thromboembolic complications”, “VTEC”, “catheter dysfunction”, “device malfunction”. Available preprints, articles with “in press” or “online first” status, and clinical cases were also included in the analysis.Conclusion. This review discusses prevention, diagnostics and treatment of venous thromboembolic complications in cancer patients using similar implantable devices. In patients with catheter-associated thromboses, of practical interest are various diagnostic and curative algorithms, recommendations on the choice of vascular access, medicamentous therapy as well as variants of surgical intervention.

A modern approach to the treatment of cancer-associated venous thromboembolic complications: a lecture

Cancer-associated venous thromboembolic complications are one of the main topical problems in the system of practical healthcare. Having overlapping pathogenetic mechanisms of development, thromboembolic complications accompany the oncological process and often act as its manifesting sign. Treatment of onco-associated venous thromboembolic complications is not an easy task, which is determined by the multiplicity of the pathogenetic mechanisms of hemostatic system disorders in the cohort of patients under consideration, who are threatened both in terms of the development of total PE and fatal bleeding. In addition to the features of the treatment phases, their duration, an important point in the treatment of cancer-associated thrombosis is a limited list of recommended drugs, as well as the permitted dosage regimens. The article analyzes the results of research aimed at studying the effectiveness of apixaban in the treatment of cancer-associated thromboembolic complications. Now the gold standard for the treatment of venous thromboembolic complications is dalteparin. However, low compliance in the use of dalteparin leads to premature termination of treatment or the patient's independent transition to alternative drugs. The appearance of direct oral anticoagulants has significantly changed the treatment paradigm in this morbid group of patients, while leaving a number of unresolved issues.

ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА, ДИАГНОСТИКА И ПРОФИЛАКТИКА ТРОМБОЗА ГЛУБОКИХ ВЕН ПРИ ПЕРЕЛОМАХ ДЛИННЫХ КОСТЕЙ НИЖНИХ КОНЕЧНОСТЕЙ

A literature review presents a data concerning the incidence and risk factors for development of venous thromboembolic complications (VTEC), as well as their diagnosis and prevention in long bones fractures of the lower extremities (LBFLE). Literature data show that, despite the widespread implementation of preventive measures in case of LBFLE, it is not always possible to completely avoid VTEC. The main risk factors for their development are the injuries’ severity, the location and nature of the extremity bone fracture, the duration of immobilization, the amount of surgery performed for bone fragments stabilization, as well as age and the presence of concomitant diseases. In the diagnosis of thrombotic process, laboratory and radiation research methods play an essential role, and according to data they has varying degrees of sensitivity and specificity. However, to date, none of them has absolute diagnostic accuracy. Complex thrombosis prophylaxis significantly reduces the risk of VTEC development, however, the choice of the type and dosage of anticoagulants, as well as the duration of their use, remain controversial, and some authors recommend different approaches in this issue. In addition, the diagnostic criteria and therapeutic tactics for embologenic floating thrombi remain open for discussion. In this regard, the conduct of large randomized scientific studies aimed at early diagnosis, prevention and treatment of VTEC using modern diagnostic tests and new generation anticoagulants is relevant and allows to minimize the risk of disability and death.

Apixaban in non-valvular atrial fibrillation and treatment of venous thromboembolism: universal safety advantage in different categories of patients

This review presents data on the frequency of bleeding in direct comparison of apixaban and vitamin K antagonists in the context of prospective randomized controlled trials. According to ARISTOTLE, AUGUSTUS and AMPLIFY studies, Apixaban has an advantage over vitamin K antagonists in terms of safety regardless of the indications (prevention of cardioembolic complications in nonvalvular atrial fibrillation, treatment of venous thromboembolic complications), which applies to all categories of patients studied, including those with increased risk of bleeding (elderly and old age, chronic renal failure, low body weight, arterial hypertension, the need for simultaneous use of one or two antiagregants, 3 or more points on the HAS-BLED scale). Moreover, the course of the accumulation curves of clinically significant bleedings indicates a constant increase in the number of patients who can prevent bleeding with prolonged use of apixaban instead of vitamin K antagonists. Prospective randomized clinical trials AMPLIFY and CARAVAGGIO show that in early treatment of proximal deep vein thrombosis of the lower limbs and/or thromboembolism of pulmonary arteries in patients without malignant tumors apixaban is safer than low-molecular-weight heparin enoxaparin, In long-term treatment of venous thromboembolic complications in patients with malignant tumors is not worse in safety than low-molecular-weight heparin dalteparin. Additional evidence for the safety of apixaban was obtained by comparing it with placebo in the prolonged treatment of venous thromboembolic complications in patients with low risk of serious bleeding in a prospective randomized controlled trial AMPLIFY-EXT.

Pharmacoeconomic analysis of protrombin complex concentrate (Octaplex preparation) use in intracerebral hemorrhage

Topicality. Anticoagulant therapy (ACT) is the basis for the prevention and treatment of venous thromboembolic complications (VTEU) after myocardial infarction (MI), acute brain disorders, atrial fibrillation (AF). As an ACT, the indirect anticoagulant warfarin is most commonly used but it may cause small and large bleedings. When developing intracerebral hemorrhage (ICH) on the background of warfarin therapy for reverse hemostatic therapy (RHT), it is recommended to use fresh frozen plasma (FFP) or of prothrombin complex concentrates (CPC).Aim. To evaluate the pharmacoeconomic feasibility of the CPC (Octaplex drug) use comparing to the emergency dose support for warfarin-associated ICH according to Ukrainian health care system.Materials and methods. Determination of the results of blood coagulant activity restoration in warfarin-associated ICH with different drugs and associated costs have been performed on soil modeling using the “decision tree” method. The model has been developed on the basis of a randomized trial of the use of FFP and CPC Octaplex warfarin-associated ICH. On the basis of modeling, the methods “total disease cost”, “cost minimization”, “cost-effectivenes” were used. The primary efficacy criterion was the proportion of patients in whom the recovery of the INR within three hours after the onset of RHT was successful. As an additional performance criterion, time was used to recover the INR. They took into account the cost of direct medical expenses, the structure of which was determined in accordance with the current Protocol. The cost of medical treatment has been determined according to the MOH registry as of 7.08.2019. The cost of medical services has been taken from the price lists in licensed clinics. A sensitivity analysis of the results has been performed prior to changes in therapy efficacy data and changes in CPC pricing.Results and discussion. Determination of direct medical expenses in accordance with the Protocol of the ICH showed that when used for the RHT FFP they amount to 154 911,2 UAH, CPC – 172 773,4 UAH. In the overall cost structure of treating a patient with ICH, the cost of RHT is almost one third. The rate of recovery of INR is an important factor that determines the time of stopping of ICR and, in turn, influences the further prognosis of the disease. Reverse CPC therapy compared to FFP allows to increase the rate of INR recovery 37 times. More than 7 times the number of patients with ICH, who manage to normalize the blood clotting index during the critical 3 hours, is increasing. The Coefficient of Cost Effectiveness (CER) for the primary criterion and the additional criterion when using a CPC is lower by 6.7 and 72.7 times, respectively. That is, using a CPC instead of a FFP is economically feasible. Sensitivity analysis confirmed the robustness of the results. By reducing the price of the CPC by 30%, it becomes the dominant medical technology, that is, providing the best clinical outcome at a lower cost.Conclusions. Pharmacoeconomic analysis with the use of tree modeling by the decision of the RHT results of warfarin-associated intracerebral hemorrhage with alternative drugs of FFP and CPC Octaplex allows to consider the use of CPC Octaplex economically viable medical technology in the current health protection conditions in Ukraine.

Apixaban role in the treatment of venous thromboembolic complications in patients with active cancer

The relationship of venous thromboembolic complications (VTEC) to cancer is well known. Modern recommendations for the treatment of VTEC in patients with cancer suggest treatment with subcutaneous injections of LMWH in the first 6 months. The emergence of evidence of comparable efficacy and safety of four OACs (dabigatran, rivaroxaban, apixaban and edoxaban) with traditional LMWH treatment and further transition to VKA led to their approval for VTEC treatment. But the efficacy and safety of OACs compared to long-term LMWH treatment in VTEC and cancer patients until recently was limited to single randomized studies (Hokusai VTE Cancer and SELECT-D), in which edoxaban and rivaroxaban were compared to dalteparin. The results were close: the recurrence rate of vTEC in oAC groups was lower than in those receiving dalteparin, but the number of bleedings was higher, mainly due to gastrointestinal bleeding. In March 2020, the results of a prospective randomized open Caravaggio study were published to demonstrate that the results of prescription of oral apixaban in order to prevent relapse of vTEC in patients with cancer-associated vTEC will not be worse than those of subcutaneous LMWH injections, and will not cause an increase in major bleedings. the study results showed that relapses of VTEC in the apixaban group were 5.6% and in the dalteparin group 7.9% (RA 0.63; 95% CI [0.371.07]; P < 0.001 for «not worse»; P = 0.09 for «better»). Heavy bleeding was observed in 3.8% of cases in the apixaban group and in 4.0% of patients receiving dalteparin (RA 0.82; 95% CI [0.40-1.69]; P = 0.60). Large gastrointestinal bleedings during treatment were recorded in 11 patients (1,9%) in the apixaban group and in 10 patients (1,7%) receiving dalteparin. oral apixaban proved to be no worse than subcutaneous dalteparin injections in the treatment of VTEC in cancer patients. Unlike studies with rivaroxaban and edoxaban, there was no increase in risk of large bleeding, including from the gastrointestinal tract, in patients receiving apixaban.

Treatment and secondary prevention of venous thromboembolism in cancer patients

Oncological patients are a high-risk group for venous thromboembolic complications. These complications significantly impair the outcome of antitumor treatment and take a leading place in the structure of mortality. Treatment of venous thromboembolic complications in oncological patients is a serious challenge. When selecting an anticoagulant, the physician should consider its efficacy and safety and possible drug interactions. Based on results of multiple studies presented in this article, physicians will be able to choose an optimum therapeutic tactics and secondary prevention of thromboembolic complications for this group of patients.

Total laparoscopic retrieval of a cava filter: case series

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.

Results of Treatment of Venous Thromboembolic Complications in a Multidisciplinary Surgical Hospital of the Republic of Sakha (Yakutia)

Results of Treatment of Venous Thromboembolic Complications in a Multidisciplinary Surgical Hospital of the Republic of Sakha (Yakutia)

Venous Thromboembolism in Patients With Spontaneous Intracerebral Hemorrhage: A Multicenter Study.

Patients with spontaneous intracerebral hemorrhage (ICH) are predisposed to venous thromboembolic (VTE) complications, such as deep vein thrombosis and pulmonary embolism. To evaluate, in a multicenter, retrospective cohort study, the rate of VTE complications in ICH patients during acute hospitalization, identify potential risk factors, and assess their association with functional outcome. We retrospectively analyzed prospectively collected data from 19 centers and 41 sites that participated in the Ethnic/Racial Variations of Intracerebral Hemorrhage study, from August 2010 to February 2016. We compared ICH patients with VTE complications to those without VTE complications. Statistical analyses were performed to determine predictors of VTE complications and poor outcome (modified Rankin Scale≥4) at discharge and 3-mo follow-up. Of the 2902 ICH patients who were eligible for analysis, 87 (3.0%) had VTE complications: 57 (2.0%) had only deep vein thrombosis, 19 (0.7%) had only pulmonary embolism, and 11 (0.4%) had both. In the multivariable logistic regression analysis, a prior history of VTE (odds ratio [OR]=6.8; P<.0001), intubation (OR=4.0; P<.0001), and presence of IVH (OR=1.8; P=.0157) were independent predictors of VTE complications. After controlling for ICH volume and location, IVH, age, and presenting Glasgow Coma Scale, the occurrence of VTE complications was an independent predictor of poor outcome at discharge (OR=2.9; P=.002) and 3-mo follow-up (OR=2.1; P=.02). Although VTE complications are uncommon after ICH, they are associated with significantly worse outcomes. Further studies will be needed to determine the optimal treatment regimen for the prevention and treatment of VTE complications in ICH patients.

Профилактика и лечение венозных тромбоэмболических осложнений в онкологии (Учебное пособие для обучающихся в системе высшего и дополнительного профессионального образования)

Учебное пособие используется для аудиторных занятий и самостоятельной работы студентов при изучении профилактики и лечения венозных тромбоэмболических осложнений у пациентов со злокачественными новообразованиями. Содержание освещает основные вопросы определения риска венозных тромбоэмболических осложнений и методы их профилактики и лечения у больных с местно-распространенными и метастатическими злокачественными новообразованиями. Учебное пособие предназначено для обучающихся в системе высшего образования (аспиранты, ординаторы, интерны, студенты) и дополнительного профессионального образования (слушатели циклов повышения квалификации). Учебное пособие утверждено в качестве учебно-методического пособия Ученым советом ФГБУ «НМИЦ онкологии им. Н. Н. Петрова» МЗ РФ (протокол № 10 от 27.09.2016). The textbook is used for classroom studies and independent work of students in the study of prevention and treatment of venous thromboembolic complications in patients with malignant tumors. The content covers the main issues of determining the risk of venous thromboembolic complications and methods of their prevention and treatment in patients with locally advanced and metastatic malignant tumors. The textbook is intended for students in higher education (graduate students, residents, interns, students) and in additional professional education (students of advanced training cycles). The textbook was approved as educating manual by the Scientifi c Council of NMRC of Oncology n. a. N. N. Petrov HM of RF (protocol № 10 from 09.27.2016).

Modern low-molecular-weight heparins in the prevention and treatment of venous thromboembolic complications in oncourologic patients

Oncourologic diseases are accompanied by a risk for subsequent venous thromboembolic complications, which are rated the most dangerous in terms of thrombogenic effect. The article presents a review of the clinical studies of efficacy and safety, and the experience in using of modern low-molecular-weight heparins in clinical practice - drugs of choice for the prevention of venous thromboembolic complications in cancer patients. Particular attention is paid to Bemiparin - a new second-generation low-molecular-weight heparin with a significant antithrombotic effect and improved pharmacological parameters that allow it to be successfully used in patients with impaired renal function in oncourological practice.

Venous thromboembolic complications in stroke: algorithm for diagnosis, prevention and treatment

Venous thromboembolic complications, which include thrombosis of deep veins, subcutaneous veins (thrombophlebitis) and thromboembolism of the pulmonary artery, for many decades remain the most important clinical problem that affects the professional field of doctors of all specialties without exception. The significance of venous thromboembolic complications is due to their extremely high potential risk for the health and life of the patient. The article presents modern information on the diagnosis, prevention and treatment of venous thromboembolic complications during stroke. The article presents the current recommendations for the appointment of drugs that affect the development of individual states and nosology with regard to the development of chronic diseases of the veins.

THROMBOSES IN ONCOLOGY. PART 1

Oncological disease increases the risk of developing arterial thrombosis mainly in the coronary and cerebrovascular beds. Among the pathogenetic mechanisms of this complication the authors consider the direct toxic effect on the endothelium produced by some groups of chemotherapeutic drugs, the procoagulant effect of the tumor, inhibition of endogenous fibrinolysis and increased platelet aggregation. Activation of the inflammation caused by increased synthesis of inflammatory mediators and adhesion molecules is also relevant, as well as vasospastic and direct damaging effects of radiation therapy on the endothelium. Patients with ACS against the background of the ongoing oncological process, on the one hand, are at a high risk for thrombotic complications, while, on the other hand, they have limitations for antiplatelet therapy due to thrombocytopenia. Therefore, the decision on the possibility, composition and duration of antiplatelet therapy in such patients should be taken by cardiologists jointly with oncologists and chemotherapists. The article has two parts. The first examines the specific hemo-stasis in cancer, some mechanisms of the pathogenesis of arterial and venous thrombosis, as well as treatment of cancer patients who developed arterial thrombosis. The second part provides a review of the literature on the prevention and treatment of venous thromboembolic complications associated with cancer.

The long path to NOAC

SummaryThe discovery of anticoagulant drugs occurred at a time when the process of blood coagulation only had been roughly described and their mode of action was unknown. Nevertheless, heparin – which was discovered 100 years ago – and warfarin – which was developed in the 1920s – had taken off on a triumphal course which is unique in medical history. The synthesis of anticoagulants with targeted mode of action was only achieved at the end of the last century, e. g. the inhibitor of factor Xa fondaparinux or the recombinant production of the direct thrombin inhibitor hirudin, closely followed by the synthesis of the direct oral inhibitors of factor Xa and thrombin. These compounds had been clinically developed in the early 21st century and meanwhile, they have become available for several indications. Dabigatran is the only thrombin inhibitor and rivaroxaban, apixaban and edoxaban are the three factor Xa inhibitors which entered the market and have started replacing the conventional anticoagulants for treatment of venous thromboembolic complications and for prevention of stroke in patients with atrial fibrillation. They have several characteristics in common such as a reproducible bioavailability, much shorter halflives than vitamin K antagonists, low interaction with other drugs, fixed dosing regimens without the necessity for routine coagulation controls and a better risk-/benefit profile than conventional anticoagulants. However, there are differences between the various compounds with regard to metabolism, renal elimination and the various dosing regimens which definitely need to be considered when prescribed to various patient populations.