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 |
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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 |
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