Short-term prognosis of breakthrough venous thromboembolism in anticoagulated patients

Autor: Pieter W. Kamphuisen, Menno V. Huisman, Marieke J. H. A. Kruip, N. van Es, Saskia Middeldorp, M. Ten Wolde, Y. W. Cheung, Charlotte E.A. Dronkers, J. Van Es, Frederikus A. Klok, Kees Meijer, Victor E. A. Gerdes
Přispěvatelé: Pulmonology, Gastroenterology and Hepatology, Vascular Medicine, Amsterdam Cardiovascular Sciences, ACS - Pulmonary hypertension & thrombosis, Amsterdam Reproduction & Development (AR&D), ACS - Atherosclerosis & ischemic syndromes, ACS - Diabetes & metabolism, Hematology, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Cardiovascular Centre (CVC)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Vitamin K
030204 cardiovascular system & hematology
DISEASE
0302 clinical medicine
Neoplasms
Prospective Studies
Aged
80 and over
RISK
education.field_of_study
Anticoagulant
Venous Thromboembolism
MOLECULAR-WEIGHT HEPARIN
Hematology
Heparin
Middle Aged
Vitamin K antagonist
Prognosis
Thrombosis
Pulmonary embolism
030220 oncology & carcinogenesis
Female
medicine.drug
Adult
medicine.medical_specialty
ANTITHROMBOTIC THERAPY
PULMONARY-EMBOLISM
medicine.drug_class
Population
CANCER-PATIENTS
Young Adult
03 medical and health sciences
Anticoagulation
Internal medicine
medicine
Humans
DOSE-ESCALATION
Breakthrough thrombotic events
Venous thrombo-embolism
education
Aged
business.industry
Anticoagulants
Malignancy
Guideline
Heparin
Low-Molecular-Weight
medicine.disease
PREVENTION
THROMBOSIS
Regimen
DEFINITION
business
Zdroj: Thrombosis research, 187, 125-130. Elsevier Limited
Thrombosis Research, 187, 125-130. Elsevier Ltd.
Thrombosis Research: Vascular Obstruction, Hemorrhage and Hemostasis, 187, 125-130. PERGAMON-ELSEVIER SCIENCE LTD
Thrombosis Research, 187, 125-130. PERGAMON-ELSEVIER SCIENCE LTD
ISSN: 0049-3848
Popis: Background: Evidence for guideline recommendations for the treatment of venous thromboembolism (VTE) during anticoagulant therapy is scarce. We aimed to observe and to describe the management of VTE occurring during anticoagulant therapy.Methods: This prospective multi-center, observational study included patients with objectively confirmed VTE during anticoagulant therapy (breakthrough event), with a follow-up of 3 months, after the breakthrough event.Results: We registered 121 patients with a breakthrough event, with a mean age of 56 years (range, 19 to 90); 61 were male (50%). Fifty-eight patients (48%) had an active malignancy. At the time of the breakthrough event, 57 patients (47%) were treated with a vitamin K antagonist (VKA), 53 patients (44%) with low-molecular-weight heparin (LMWH) and 11 patients (9%) with direct oral anticoagulants, unfractionated heparin, or VKA plus LMWH. A total of 21 patients (17%) were receiving a subtherapeutic dose of an anticoagulant. The main regimens to treat recurrence in patients on VKA were: switch to LMWH (33%), temporary double treatment with LMWH and VKA (23%), and VKA with a higher target INR (19%). In patients with a breakthrough on LMWH, the most frequently chosen regimen was a permanent dose increase (74%). During 3-month follow-up, 7% of patients had a second breakthrough event and 8% experienced major or clinically relevant non-major bleeding.Conclusion: There is wide variation in the management of VTE during anticoagulant treatment, reflecting a heterogeneous and complex clinical situation. Despite intensifying anticoagulation, the risk of a second breakthrough event in this population is 7%.
Databáze: OpenAIRE
Externí odkaz: