Best practice & research. Clinical haematology
-
The standard effective treatment of venous and arterial thromboembolism includes unfractionated and low-molecular weight heparin as well as warfarin, which have major disadvantages. In recent years, new anticoagulants have been developed in an attempt to overcome the known limitations of established treatment and develop improved therapies. This chapter reviews pharmacological properties of the new anticoagulants, the most recent trials assessing their safety and efficacy as well as potential advantages and disadvantages of using these novel drugs in real life.
-
Best Pract Res Clin Haematol · Sep 2012
ReviewEpidemiology, diagnosis, treatment and management of superficial-vein thrombosis of the legs.
Recent data on lower-limb superficial-vein thrombosis (SVT) may substantially impact its clinical management. Particularly, the clear confirmation that SVT is closely linked to deep-vein thrombosis (DVT) or pulmonary embolism (PE) highlights the potential severity of the disease. DVT or PE is diagnosed in 20-30% of SVT patients. ⋯ Superficial-vein thrombosis (SVT) of the lower limbs has long been regarded as a benign, self-limiting disease, expected to resolve spontaneously and rapidly, and requiring only symptomatic treatments [1,2]. However, the perception of this disease is now changing with the recent publication of data indicating its potential severity [3] and showing for the first time the benefit of a therapeutic strategy based on the administration of an anticoagulant treatment [4]. The overall management of this frequent disease therefore needs to be reconsidered.
-
Best Pract Res Clin Haematol · Sep 2012
ReviewThrombolytic therapy for submassive pulmonary embolism.
Approximately 10% of all patients with acute pulmonary embolism (PE) die within the first three months after diagnosis. However, PE is not universally life-threatening, but covers a wide spectrum of clinical severity and death risk. Thrombolytic treatment is indicated patients with acute massive PE who are at high risk for early death, i.e. those patients who present with arterial hypotension and shock. ⋯ These data provide the rationale for a large multinational randomized trial which has set out to determine whether normotensive patients with right ventricular dysfunction, detected by echocardiography or computed tomography, plus evidence of myocardial injury as indicated by a positive troponin test, may benefit from early thrombolytic treatment. This study, which is underway in 13 European countries, will enroll a total of 1000 patients and will be completed in 2012. Together with a parallel trial currently being conducted in the United States, it will hopefully answer the question whether thrombolysis is indicated in submassive PE, thus terminating a 40-year-old debate and filling an important gap in our management concept for acute pulmonary embolism.
-
Best Pract Res Clin Haematol · Sep 2012
ReviewAdvances in the diagnosis and management of postthrombotic syndrome.
Postthrombotic syndrome (PTS) is a frequent long-term complication of deep vein thrombosis (DVT). Known risk factors include obesity, recurrent ipsilateral DVT, iliofemoral DVT, persistent symptoms one month after DVT diagnosis, and having subtherapeutic INRs greater than 50% of the time during the first few months on anticoagulant therapy. Other risk factors remain under investigation. ⋯ Though not well studied, there are surgical options for severe cases of PTS refractory to other treatments. Ongoing clinical trials should provide insight on risk factors, and interventions for PTS prevention and treatment. In particular, use of early thrombolysis for acute iliofemoral DVT to prevent PTS is currently being investigated.