scholarly journals New Paradigms of Extended Thromboprophylaxis in Medically Ill Patients

2020 ◽  
Vol 9 (4) ◽  
pp. 1002 ◽  
Author(s):  
Kira MacDougall ◽  
Alex C Spyropoulos
Keyword(s):  
Health Care Providers ◽  
Selection Criteria ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Care Providers ◽  
Medically Ill ◽  
Patient Selection Criteria ◽  
Net Clinical Benefit ◽  
Medically Ill Patients ◽  
Patient Subgroups

Extended thromboprophylaxis given to medically ill patients for up to 45 days following an acute hospitalization remains an emerging topic among many hospital-based health care providers. Recent advancements in the field of extended thromboprophylaxis using risk stratification and careful patient selection criteria have led to an improved safety profile of direct oral anticoagulants (DOACs) and established net clinical benefit when given to key patient subgroups at high risk of venous thromboembolism (VTE) and low risk of bleeding. The Food and Drug Administration (FDA) has now approved the DOACs betrixaban and rivaroxaban for both in-hospital and extended thromboprophylaxis in medically ill patients in these key subgroups, which represents more than one-quarter of hospitalized medically ill patients. This has potential to significantly reduce VTE-related morbidity and mortality for these patients. Emerging data also supports reductions in the risk of arterial thromboembolism in medically ill patients with extended thromboprophylaxis post-hospital discharge using DOACs. This article aims to review the most recent concepts of predicting and preventing VTE and to discuss emerging paradigms of extended thromboprophylaxis in hospitalized medically ill patients utilizing an individualized, risk-adapted approach.

Prevention of Venous Thromboembolism in Acutely Ill Medical Patients: A New Era

2021 ◽  
Vol 42 (02) ◽  
pp. 308-315
Author(s):  
Kira MacDougall ◽  
Alex C. Spyropoulos
Keyword(s):  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Preventive Strategy ◽  
Medical Patients ◽  
New Era ◽  
Medically Ill ◽  
Increased Risk ◽  
Medically Ill Patients ◽  
Patient Subgroups

AbstractVenous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.

The use of direct oral anticoagulants for extended duration thromboprophylaxis in medically ill patients: a systematic review and meta-analysis

2019 ◽  
Vol 48 (3) ◽  
pp. 422-429 ◽  
Author(s):  
Reema A. Alshouimi ◽  
Shahad M. Al Rammah ◽  
Mohammed Y. Alzahrani ◽  
Hisham A. Badreldin ◽  
Majed S. Al Yami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Medically Ill ◽  
Extended Duration ◽  
Medically Ill Patients

scholarly journals Home Management of the Device Detected Atrial Fibrillation during COVID-19 Pandemic: A Case Report

2021 ◽  
Vol 9 (C) ◽  
pp. 170-173
Author(s):  
Idaliya Rakhimova ◽  
Talgat Khaibullin ◽  
Yerbol Smail ◽  
Zhanar Urazalina ◽  
Vitalii Koval`chuk ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Health Care Providers ◽  
Remote Monitoring ◽  
Beta Blockers ◽  
Oral Anticoagulants ◽  
Home Monitoring ◽  
Phone Call ◽  
Care Providers ◽  
Remote Monitoring System

BACKGROUND: Patients with heart failure (HF) and implanted heart devices constitute a vulnerable category during the coronavirus disease –2019 (COVID-19) pandemic. The remote monitoring function allows the physician to detect atrial fibrillation (AF) in these patients and to prevent thromboembolic complications by prescribing anticoagulants. Under quarantine conditions, such patients can receive fully remote consultation and treatment, which will protect them from the risk of infection, and also reduce the burden on medical institutions. CASE REPORT: A 56-year-old man presented to the clinic with shortness of breath when climbing the second floor, moderate non-specific fatigue, general weakness, and a decrease in exercise tolerance. The patient received standard treatment for HF for at least 3 months (ACEI, beta blockers, MR antagonists, and loop diuretics) in individually selected adequate doses. ECG on admission showed a QRS of 150 ms, left bundle branch block (LBBB). Echo showed dilatation of all heart chambers, diffuse hypokinesis of the walls with akinesis of the apical, middle anterior LV segments, as well as hypokinesis of the basal, middle apical, and anterior septal segment of the LV. The ejection fraction was reduced to 35%. RV function is reduced. After a detailed discussion with the team, it was decided to do implantation of a cardioverter-defibrillator with resynchronization function, equipped with remote monitoring (Biotronik, and Home monitoring). Date of implantation is June 19, 2014. Due to the fact that the patient was connected to the remote monitoring system, May 5, 2020, he was diagnosed with asymptomatic AF. The episode lasted 1 min 22 s. On the following days of monitoring, episodes of AF were also recorded. The duration of the episodes ranged from a few seconds to 12 h/day. The patient received a doctor’s consultation through phone call, his risk of stroke was four when assessed using the CHA2DS2VASc scale. In treatment, it was recommended to add antiarrhythmic drugs (amiodarone 600 mg a day) and oral anticoagulants (rivaroxaban 20 mg × 1 time/day). Later, periodic IEGM showed absence of AF. CONCLUSION: In the context of the COVID-19 pandemic, health-care providers should rethink their approach to managing patients with implanted heart devices. Modern cardiovascular implantable electronic devices allow the physician to monitor the status of patients and immediately respond to situations requiring a change in treatment. Consultations can be carried out completely online.

scholarly journals Thromboprophylaxis in nonsurgical patients

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 631-637 ◽  
Author(s):  
Michael B. Streiff ◽  
Brandyn D. Lau
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Pharmacologic Prophylaxis ◽  
Medically Ill Patients

Abstract Venous thromboembolism (VTE) is an important cause of preventable morbidity and mortality in medically ill patients. Randomized controlled trials indicate that pharmacologic prophylaxis reduces deep venous thrombosis (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.36-0.59) and pulmonary embolism (RR = 0.49; 95% CI, 0.33-0.72) with a nonsignificant trend toward more bleeding (RR = 1.36; 95% CI, 0.80-2.33]. Low-molecular-weight heparin (LMWH) and unfractionated heparin are equally efficacious in preventing deep venous thrombosis (RR = 0.85; 95% CI, 0.69-1.06) and pulmonary embolism (RR = 1.05; 95% CI, 0.47-2.38), but LMWH is associated with significantly less major bleeding (RR = 0.45; 95% CI, 0.23-0.85). LMWH is favored for VTE prophylaxis in critically ill patients. New VTE and bleeding risk stratification tools offer the potential to improve the risk-benefit ratio for VTE prophylaxis in medically ill patients. Intermittent pneumatic compression devices should be used for VTE prophylaxis in patients with contraindications to pharmacologic prophylaxis. Graduated compression stockings should be used with caution. VTE prevention in medically ill patients using extended-duration VTE prophylaxis and new oral anticoagulants warrant further investigation. VTE prophylaxis prescription and administration rates are suboptimal and warrant multidisciplinary performance improvement strategies.

New paradigms in venous thromboprophylaxis of medically ill patients

2017 ◽  
Vol 117 (09) ◽  
pp. 1662-1670 ◽  
Author(s):  
Alex C. Spyropoulos ◽  
Gary E. Raskob
Keyword(s):  
Large Scale ◽  
Population Based ◽  
Medical Patients ◽  
Post Discharge ◽  
Patient Centered ◽  
Medically Ill ◽  
Risk Assessment Models ◽  
Net Clinical Benefit ◽  
Medically Ill Patients ◽  
Review Current

SummaryAcutelly-ill hospitalised medical patients are at risk of venous thromboembolism (VTE), both in-hospital and in the immediate post-discharge period, and mortality from VTE is thought to be particularly high in this patient population. However, despite previous mandates from international antithrombotic guidelines such as those of the American College of Chest Physicians (ACCP) for the “universal” use of thromboprophylaxis in hospitalised medical patients, global audits suggest that implementation of thromboprophylaxis continues to be challenging because of the perceived higher risk of bleeding and lower risk of VTE than that reported in clinical trials. Recent population-based studies also reveal that a “universal” hospital-only thromboprophylactic strategy does not reduce the community burden of VTE from this population, which may constitute nearly one quarter of the attributable risk of VTE. Lastly, four large randomised placebo-controlled trials of extended thromboprophylaxis have failed to show a definitive net clinical benefit in hospitalised medical patients. Recent large-scale efforts in deriving and validating scored VTE and bleed risk assessment models (RAMs) have been completed in the medically-ill population. In addition, an elevated D-dimer as a new biomarker to identify at-VTE risk medically ill patients has also undergone prospective evaluation. This paper will review current concepts of VTE and bleed risk in hospitalised medical patients, both in the hospital as well as the post-hospital discharge period, and will discuss new paradigms of thromboprophylaxis in this population using an individualised, patient-centered approach.

scholarly journals Developments in the management and treatment of pulmonary embolism

2015 ◽  
Vol 24 (137) ◽  
pp. 484-497 ◽  
Author(s):  
Rachel Limbrey ◽  
Luke Howard
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Primary Care Providers ◽  
Similar Efficacy ◽  
Individual Risk ◽  
Care Providers ◽  
Outpatient Services ◽  
Risk Patients

Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach. Individual risk stratification directs initial treatment. Rates of recurrence differ between subgroups of patients with PE; therefore, a review of provoking factors, along with the risks of morbidity and bleeding, guides the duration of ongoing anticoagulation. The direct oral anticoagulants have shown similar efficacy and, in some cases, reduced major bleeding compared with standard approaches for acute treatment. They also offer the potential to reduce the burden on patients and outpatient services in the post-hospital phase. Rivaroxaban, dabigatran and apixaban have been shown to reduce the risk of recurrent venous thromboembolism versus placebo, when given for >12 months. Patients receiving direct oral anticoagulants do not require regular coagulation monitoring, but follow-up, ideally in a specialist PE clinic in consultation with primary care providers, is recommended.

Prevention of Venous Thromboembolism with New Oral Anticoagulants versus Standard Pharmacological Treatment in Acute Medically Ill Patients

Drugs ◽  
2012 ◽  
Vol 72 (13) ◽  
pp. 1755-1764 ◽  
Author(s):  
Ida Ehlers Albertsen ◽  
Torben Bjerregaard Larsen ◽  
Lars Hvilsted Rasmussen ◽  
Thure Filskov Overvad ◽  
Gregory Y.H. Lip
Keyword(s):  
Venous Thromboembolism ◽  
Pharmacological Treatment ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Medically Ill ◽  
Medically Ill Patients
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