http://www.expertoentrombosis.com 2010-05-05T19:09:22Z

Rivaroxaban has demonstrated comparable safety and superior efficacy to the commonly used low-molecular-weight heparin, enoxaparin. Ongoing and future clinical trials will allow clinicians to further assess the efficacy, safety, and pharmacoeconomics of rivaroxaban.

The case-fatality rates of recurrent VTE and major bleeding events are similar during the initial period of VTE treatment. The case-fatality rate of recurrent VTE decreases after completion of the initial period of anticoagulation. When combined with absolute rates of recurrent VTE and major bleeding events, case-fatality rates provide clinicians with a surrogate measure of mortality to balance the risks and benefits of anticoagulant therapy in patients with VTE.

Use of the pulmonary embolism rule-out criteria (PERC) can decrease the number of unnecessary computed tomography pulmonary angiography (CTPA) tests performed on low-risk patients in the emergency department to rule out a possible pulmonary embolism (PE), according to a study to be presented at the ARRS 2010 Annual Meeting in San Diego, CA.

The discrepancy between the relatively low accuracy of perfusion SPECT plus low-dose CT and the high accuracy of V/Q SPECT plus CT in the study is considerable. It would be important to reanalyze the data to define the scintigraphic pattern responsible for the low specificity, 51%, when perfusion SPECT plus CT was used instead of V/Q SPECT plus CT. The information gained from this reanalysis would help us better understand the strengths and pitfalls of perfusion SPECT and help improve diagnostic confidence and accuracy.

An association between body height and venous thromboembolism (VTE) has been suggested by previous studies including males only. The aim of this prospective cohort study was to investigate the sex-specific impact of body height on risk of VTE in a general population.

Silent pulmonary embolism sometimes involved central pulmonary arteries. Because approximately one third of patients with deep venous thrombosis have silent pulmonary embolism, routine screening for pulmonary embolism may be advantageous.

The ACCP recommends IVC filter placement in patients with proven venous thromboembolism (VTE), those with a contraindication for anticoagulation, and those with a complication of anticoagulation therapy, as well as recurrent VTE despite adequate anticoagulation.

Used as an adjunct to thrombolysis, the low-molecular-weight heparin enoxaparin lowers death and myocardial infarctions (MIs) at 1 year compared with unfractionated heparin in patients with ST-segment elevation myocardial infarction (STEMI). According to the findings, published online April 17, 2010, ahead of print in the European Heart Journal, the benefit was driven by a reduction in MIs within the first 30 days.

Obesity and smoking were both found to be important risk factors for VTE whereas total/high-density lipoprotein/low-density lipoprotein cholesterol levels, triglyceride levels, and diabetes mellitus were not.

Patients who received clopidogrel plus a PPI had a significantly higher risk of rehospitalization for MI or coronary stent placement than did patients receiving clopidogrel alone. Prospective clinical trials and laboratory analyses of biochemical interactions are warranted to further evaluate the potential impact of PPIs on the efficacy of clopidogrel.

Stent malapposition was unique to DES-related VLST, whereas disease progression with neointimal rupture was more common in BMS patients. These findings suggest that different biological mechanisms underlie VLST development depending upon the stent type.

Patients with intracranial hemorrhage due to traumatic brain injury are at high risk of developing venous thromboembolism including deep vein thrombosis (DVT) and pulmonary embolism (PE). Thus, there is a trade-off between the risks of progression of intracranial hemorrhage (ICH) versus reduction of DVT/PE with the use of prophylactic anticoagulation. Using decision analysis modeling techniques, we developed a model for examining this trade-off for trauma patients with documented ICH.

There is clearly a need for appropriate steps to be taken to reduce the impact on QoL and cost of VTE after major orthopaedic surgery. It is impractical to carry out routine screening to identify patients with DVT in order that they may be treated. Hence, primary prevention of VTE is recommended for all patients undergoing major orthopaedic surgery of the lower limb.

Oral administration, predictable anticoagulant responses, low potential for drug-drug interactions and first published clinical data render direct thrombin and factor Xa inhibitors good candidates to replace oral vitamin K antagonist and low molecular weight heparins for DVT treatment.

A small blood lab that fits into the pocket of a jacket can quickly analyze the risk of blood clots in legs prior to a long distance flight; a sensor wristband for measuring electric smog can warn pacemaker patients of life-threatening exposure: "Smart plastics" can turn such tools into reality. The scientists at the Fraunhofer Institute for Reliability and Microintegration IZM in Munich are intensely working on these topics.

A small blood lab that fits into the pocket of a jacket can quickly analyze the risk of blood clots in legs prior to a long distance flight; a sensor wristband for measuring electric smog can warn pacemaker patients of life-threatening exposure: "Smart plastics" can turn such tools into reality. The scientists at the Fraunhofer Institute for Reliability and Microintegration IZM in Munich are intensely working on these topics.

The authors concluded that magnetic resonance pulmonary angiography should be considered only at centers that routinely perform it well, and only for patients for whom standard tests are contraindicated. In patients with technically adequate images, combined magnetic resonance pulmonary angiography and magnetic resonance venography have a higher sensitivity than does magnetic resonance pulmonary angiography alone, but it is more difficult to obtain technically adequate images with the two procedures.

One in 6 patients delay filling their index clopidogrel prescription after hospital discharge after DES implantation. This delay was associated with increased risk of adverse outcomes and highlights the importance of the transition period from hospital discharge to outpatient setting as a potential opportunity to improve care delivery and patient outcomes.

Our review findings suggest there is still considerable uncertainty between a 10mg and a 5mg loading dose for initiation of warfarin. In the elderly, where time to in range is not as important, lower initiation doses or age adjusted doses are more appropriate, leading to less higher INRs. Currently there is insufficient evidence to warrant genotype guided initiation, and adequately powered trials to detect effects on adverse events are currently warranted.

Compared with UFH for 48 h, a strategy using enoxaparin as an adjunct to fibrinolysis resulted in a sustained reduction in death or MI at 1 year with no additional benefit after 30 days. Mortality was not reduced at 1 year with the enoxaparin strategy.