scholarly journals The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism: comment

2018 ◽  
Vol 16 (12) ◽  
pp. 2537-2539
Author(s):  
J. D. Brown ◽  
A. Goodin ◽  
G. Y. H. Lip
Keyword(s):  
Venous Thromboembolism ◽  
Risk Of Bleeding ◽  
Chest Physician

scholarly journals The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism

2018 ◽  
Vol 16 (10) ◽  
pp. 1994-2002 ◽  
Author(s):  
G. Palareti ◽  
E. Antonucci ◽  
D. Mastroiacovo ◽  
W. Ageno ◽  
V. Pengo ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Risk Of Bleeding ◽  
Chest Physician

The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism: reply

2018 ◽  
Vol 16 (12) ◽  
pp. 2539-2540 ◽  
Author(s):  
G. Palareti ◽  
E. Antonucci ◽  
W. Ageno ◽  
D. Mastroiacovo ◽  
D. Poli ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Risk Of Bleeding ◽  
Chest Physician

Risk Factors for Bleeding during Treatment of Acute Venous Thromboembolism

1996 ◽  
Vol 76 (05) ◽  
pp. 682-688 ◽  
Author(s):  
Jos P J Wester ◽  
Harold W de Valk ◽  
Karel H Nieuwenhuis ◽  
Catherine B Brouwer ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Small Body ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Risk Of Bleeding ◽  
Acute Venous Thromboembolism

Summary Objective: Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism. Design: Secondary analysis of a prospective, randomized, assessor-blind, multicenter clinical trial. Setting: One university and 2 regional teaching hospitals. Patients: 188 patients treated with heparin or danaparoid for acute venous thromboembolism. Measurements: The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively. Results: Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area ≤2 m2 (odds ratio 2.3, 95% Cl 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% Cl 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders. Conclusions: A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.

Primary prevention of venous thromboembolism

2012 ◽  
Vol 27 (2_suppl) ◽  
pp. 23-32 ◽  
Author(s):  
R S Figueiredo ◽  
G Stansby ◽  
V Bhattacharya
Keyword(s):  
Venous Thromboembolism ◽  
Arterial Disease ◽  
Low Molecular Weight ◽  
Compression Stockings ◽  
Low Molecular Weight Heparins ◽  
Pharmacological Prophylaxis ◽  
Risk Of Bleeding ◽  
Peripheral Arterial ◽  
Orally Active ◽  
Pharmacological Thromboprophylaxis

Venous thromboembolism (VTE) is the most common cause of preventable in-hospital mortality and all hospitalized patients should be VTE risk assessed. The VTE risk should be weighed up against risk of bleeding on an individualized basis to guide choice of prophylaxis. The most common method of mechanical thromboprophylaxis is graduated compression stockings, although others, such as intermittent pneumatic devices, are available. Stockings have the greatest benefit when used in combination with pharmacological prophylaxis. However, stockings are contraindicated in some patients, including those with stroke or peripheral arterial disease. Various options for pharmacological thromboprophylaxis are available. The most commonly used agents are the low-molecular-weight heparins, but newer orally active agents may play an increasing role in the future.

Long-term quality of VKA treatment and clinical outcome after extreme overanticoagulation in 14,777 AF and VTE patients

2015 ◽  
Vol 113 (04) ◽  
pp. 881-890 ◽  
Author(s):  
Nic J. G. M. Veeger ◽  
Nakisa Khorsand ◽  
Hanneke C. Kluin-Nelemans ◽  
Hilde A. M. Kooistra ◽  
Karina Meijer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Clinical Outcome ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
P Value ◽  
Risk Of Bleeding ◽  
Increased Risk

SummaryVitamin K antagonists (VKA) are widely used in atrial fibrillation and venous thromboembolism (VTE). Their efficacy and safety depend on individual time in the therapeutic range (iTTR). Due to the variable dose-response relationship within patients, also patients with initially stable VKA treatment may develop extreme overanticoagulation (EO). EO is associated with an immediate bleeding risk, but it is unknown whether VKA treatment will subsequently restabilise. We evaluated long-term quality of VKA treatment and clinical outcome after EO. EO was defined as international normalized ratio (INR) ≥ 8.0 and/or unscheduled vitamin K supplementation. We included a consecutive cohort of initially stable atrial fibrillation and venous thromboembolism patients. In EO patients, the 90 days pre- and post-period were compared. In addition, patients with EO were compared with patients without EO using a matched 1:2 cohort. Of 14,777 initially stable patients, 800 patients developed EO. The pre-period was characterised by frequent overanticoagulation, and half of EO patients had an inadequate iTTR (< 65 %). After EO, underanticoagulation became more prevalent. Although the mean time between INR-measurements decreased from 18.6 to 13.2 days, after EO inadequate iTTR became more frequent (62 %), p-value < 0.001. A 2.3 times (95 % confidence interval [CI] 2.0–2.5) higher risk for iTTR< 65 % after EO, was accompanied by increased risk of bleeding (hazard ratio [HR] 2.1;CI 1.4–3.2), VKA-related death 17.0 (HR 17.0;CI 2.1–138) and thrombosis (HR 5.7;CI 1.5–22.2), compared to the 1600 controls. In conclusion, patients continuing VKA after EO have long-lasting inferior quality of VKA treatment despite intensified INR-monitoring, and an increased risk of bleeding, thrombosis and VKA-related death.Note: There have been no previous presentations, reports or publications of the complete data that appear in the article. Parts of the data in this article have been presented as a poster at the American Society of Hematology (ASH) congress 2013, New Orleans, United States.

scholarly journals Modified IMPROVE VTE Risk Score and Elevated D-Dimer Identify a High Venous Thromboembolism Risk in Acutely Ill Medical Population for Extended Thromboprophylaxis

TH Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e59-e65 ◽  
Author(s):  
Alex C. Spyropoulos ◽  
Concetta Lipardi ◽  
Jianfeng Xu ◽  
Colleen Peluso ◽  
Theodore E. Spiro ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Score ◽  
Lower Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Cutoff Score ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
D Dimer

AbstractAn individualized approach to identify acutely ill medical patients at increased risk of venous thromboembolism (VTE) and a low risk of bleeding to optimize the benefit and risk of extended thromboprophylaxis (ET) is needed. The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE risk score has undergone extensive external validation in medically ill patients for in-hospital use and a modified model was used in the MARINER trial of ET also incorporating an elevated D-dimer. The MAGELLAN study demonstrated efficacy with rivaroxaban but had excess bleeding. This retrospective analysis investigated whether the modified IMPROVE VTE model with an elevated D-dimer could identify a high VTE risk subgroup of patients for ET from a subpopulation of the MAGELLAN study, which was previously identified as having a lower risk of bleeding. We incorporated the modified IMPROVE VTE score using a cutoff score of 4 or more or 2 and 3 with an elevated D-dimer (>2 times the upper limit of normal) to the MAGELLAN subpopulation. In total, 56% of the patients met the high-risk criteria. In the placebo group, the total VTE event rate at Day 35 was 7.94% in the high-risk group and 2.83% for patients in the lower-risk group. A reduction in VTE was observed with rivaroxaban in the high-risk group (relative risk [RR]: 0.68, 95% confidence interval [CI]: 0.51–0.91, p = 0.008) and in the lower-risk group (RR: 0.69, 95% CI: 0.40 -1.20, p = 0.187). The modified IMPROVE VTE score with an elevated D-dimer identified a nearly threefold higher VTE risk subpopulation of patients where a significant benefit exists for ET using rivaroxaban.

scholarly journals Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

2019 ◽  
Vol 6 (1) ◽  
pp. 83-88
Author(s):  
Ujjawal Paudel ◽  
Prashant Raj Bhatt ◽  
Choodamani Nepal
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Acute Infection ◽  
Tertiary Care ◽  
Medical Ward ◽  
Assessment Model ◽  
Medical Patients ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding

 Introductions: Studies have shown inadequate use of prophylaxis for venous thromboembolism (VTE) in hospital admitted medical patients. This study aims to evaluate the use of VTE prophylaxis in admitted medical patients in a tertiary care teaching hospital. Methods: This was a cross sectional observational study for three weeks from 19 March to 8 April 2017 in patients admitted in the medical ward of Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Patient charts were reviewed for appropriate VTE prophylaxis as per modified Padua risk Assessment model. Risks of VTE, presence of bleeding risks, demographics (age, BMI), hospital stay were descriptively analysed. Results: Out of 122 patients, 81 (66.4%) were at risk of VTE. Among 81 at risk, 69 were eligible for VTE pharmacoprophylaxis with no risk of bleeding only 29 (42%) received pharmacoprophylaxis and 12 eligible for prophylaxis but with the risk of bleeding did not receive any prophylaxis. Reduced mobility was the most common indication of thromboprophylaxis in 79 (64%), followed by acute infection 50 (41%). Conclusions: There was suboptimal use of thromboprophylaxis in hospital admitted medical patients at risk of venous thromboembolism, VTE.

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