Journal of thrombosis and haemostasis : JTH
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J. Thromb. Haemost. · Jan 2013
Review Practice GuidelineInternational clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer.
Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. ⋯ Dissemination and implementation of good clinical practice for the management of VTE, the second cause of death in cancer patients, is a major public health priority.
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J. Thromb. Haemost. · Oct 2012
ReviewPhase III studies on novel oral anticoagulants for stroke prevention in atrial fibrillation: a look beyond the excellent results.
In this overview we address the three phase III studies that compared new oral anticoagulants (dabigatran, rivaroxaban and apixaban) with warfarin in the setting of stroke prevention in atrial fibrillation. Strengths and weaknesses of the studies were examined in detail through indirect comparison. We analyze and comment the inclusion and exclusion criteria, the characteristics of randomized patients, the primary efficacy and safety end points and side effects. ⋯ Both dabigatran and apixaban were tested in low- to moderate-risk patients (mean CHADS2 [Congestive heart failure, Hypertension, Age, Diabetes, Stroke] score = 2.1-2.2) whereas rivaroxaban was tested in high-risk patients (mean CHADS2 score = 3.48) and at variance with dabigatran and apixaban was administered once daily. Apixaban significantly reduced mortality from any cause. The choice of a new oral anticoagulant should take into account these and other differences between the new drugs.
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J. Thromb. Haemost. · Aug 2012
ReviewSymptomatic subsegmental pulmonary embolism: what is the next step?
The introduction of computed tomography pulmonary angiography (CTPA) has led to an increase in the incidence of pulmonary embolism (PE) diagnosis. However, the case fatality rate is lower and the mortality rates of PE have remained unchanged, suggesting a lower severity of illness. Specifically, the multiple-detector CTPA increased the rate of subsegmental filling defect reported in patients with suspected PE. ⋯ Only a small number of patients with SSPE diagnosed by CTPA and without DVT who did not receive anticoagulation treatment have been reported in the literature. None of these patients suffered recurrent symptomatic VTE (PE or DVT) during the 3-month follow-up period (0%; 95% CI, 0-7.4%), suggesting that SSPE might be clinically unimportant. These conclusions are only hypothesis generating and need to be confirmed in prospective clinical management studies before changing clinical practice.
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J. Thromb. Haemost. · Aug 2012
ReviewEpidemiology and prevention of catheter-related thrombosis in patients with cancer.
Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to catheter-related thrombosis (CRT). ⋯ Efforts to reduce thrombotic complications, involving flushing the catheter with heparinized solutions, the use of heparin-bonded catheters, and systemic anticoagulant prophylaxis, have been largely ineffective. More studies are needed to understand the pathophysiology of thrombotic complications, to help identify effective interventions to reduce this adverse outcome.
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J. Thromb. Haemost. · Jul 2012
Review Meta AnalysisPrognostic clinical prediction rules to identify a low-risk pulmonary embolism: a systematic review and meta-analysis.
Prognostic assessment is important for the management of patients with a pulmonary embolism (PE). A number of clinical prediction rules (CPRs) have been proposed for stratifying PE mortality risk. The aim of this systematic review was to assess the performance of prognostic CPRs in identifying a low-risk PE. ⋯ Prognostic CPRs efficiently identify PE patients at a low risk of mortality. Before implementing prognostic CPRs in the routine care of PE patients, well-designed management studies are warranted.