J Mal Vascul
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Over 1,400,000 cases of hand trauma are identified each year in France, with a large proportion with open wounds, accounting for significant activity in orthopedic surgery emergency units. It is customary to focus on nerve or tendon injuries as a priority. However, even partial vascular lesions may be complicated by a false aneurysm. ⋯ Otherwise, a revascularization procedure must be considered. Some authors propose new less invasive treatments as an alternative to surgery. Even though surgery is relatively simple, the best means of prevention still remains a systematic exploration of vascular elements in case of a hand wound.
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Heparins and vitamin K antagonists (VKA) used commonly are the standard treatment of venous and arterial thromboses. They are very efficient and safe, but have some limitations: iatrogenicity, laboratory monitoring, parenteral use for heparins and fondaparinux. Nowadays, four new inhibitors of factor Xa are used orally (rivaroxaban, apixaban, edoxaban, betrixaban), and they are at least as efficient as heparins and vitamin K antagonists. ⋯ Apixaban is another direct inhibitor of factor Xa used orally which is developed in the same indications as rivaroxaban. Edoxaban and betrixaban are also in development. The objective of this work is to study the pharmacodynamic, pharmacokinetic, the efficacy and safety of these four oral direct factor Xa inhibitors.
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The study objective was to evaluate the potential increase in fatal bleeding risk related to curative anticoagulation of asymptomatic deep venous thromboses diagnosed by routine ultrasound screening after total hip/knee replacement or hip fracture using data from a comprehensive literature review. ⋯ Curative anticoagulation of asymptomatic distal deep vein thromboses, leads to more fatal bleeding compared to avoidable fatal pulmonary embolism. These findings strengthen recommendations against routine ultrasound screening for asymptomatic distal deep vein thrombosis.
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Assessment of cancer screening in the context of venous thromboembolic disease (VTE) remains controversial. We tried to characterize a population at high risk of developing cancer among patients suffering from VTE. ⋯ Bilateral venous thrombosis and D-dimers superior to 3.8 μg/mL are highly associated with carcinoma. This result requires a prospective validation. It could be useful in limiting the screening process to the population most at risk.
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Editorial Comment
[Aspirin for preventing the recurrence of venous thromboembolism].