Clinics in chest medicine
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Clinics in chest medicine · Mar 2003
ReviewLocal and systemic thrombolytic therapy for acute venous thromboembolism.
Thrombolytic therapy unquestionably leads to more rapid and complete clot lysis with a significantly higher risk of bleeding when compared with anticoagulation. The most definite indication for thrombolytic therapy in patients with VTE is massive PE associated with hemodynamic instability. ⋯ Routine use of thrombolytic therapy in all other cases of PE and DVT cannot be justified. Future research using randomized controlled studies should focus on the following key questions: Do hemodynamically stable patients with PE and right ventricular dysfunction benefit from thrombolysis, and, if so, is there a subset of patients within this group who are most likely to benefit? Does thrombolytic therapy improve long-term outcomes of DVT with a favorable risk-to-benefit ratio, and, if so, which patients are most likely to benefit long-term? What is the precise role of catheter-directed thrombolysis in the treatment of VTE, particularly the use of a low-dose thrombolytic agent in conjunction with mechanical clot disruption to minimize bleeding in patients at high risk? Until these questions are answered, clinicians must approach decision-making regarding the use of thrombolytic therapy in PE and DVT with careful consideration of the potential risks and benefits for the patient within the framework of currently available data.
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Clinics in chest medicine · Mar 2003
ReviewPrevention and management of venous thromboembolism in pregnancy.
Pulmonary thromboembolism is a major cause of maternal mortality. DVT causes significant morbidity in pregnancy and in later life owing to the post-thrombotic syndrome. ⋯ Greater use of prophylaxis is needed after vaginal delivery. Because acute VTE is relatively uncommon, greater use of proposed guidelines [24,84,85] may be of value in improving management, but the involvement of clinicians with expertise in the management of these cases is also important.
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Clinics in chest medicine · Mar 2003
ReviewVenous thromboembolism prophylaxis in the medically ill patient.
All general medical patients should be assessed for clinical risk factors for VTE. The ACCP has recommended that general medical patients with clinical risk factors receive either LDUH twice or three times daily or once-daily LMWH. ⋯ The preferred strategy for prevention in the medically ill population at high to very high risk for VTE is LMWH. For patients who have a high to very high risk for bleeding, nonpharmacologic strategies such as ES or IPC devices are recommended.
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Clinics in chest medicine · Mar 2003
The evolution and impact of the American College of Chest Physicians consensus statement on antithrombotic therapy.
The evolution of the American College of Chest Physicians consensus on antithrombotic therapy is reviewed, specifically with regard to the prevention and treatment of venous thromboembolism and the rules of evidence applied. A perspective on the impact of the recommendations is offered.