Broad syntheses related to this topic

loading
7 References (7 articles) loading Revert Studify

Broad synthesis / Living FRISBEE

Unclassified

Is it worth adding an inferior vena cava filter to anticoagulation in thromboembolic disease?

Auteurs Yunes A , Aizman A
Journal Medwave
Year 2017
Liens Pubmed DOI

Cet article inclut 3 Systematic reviews Systematic reviews (3 references) 6 Primary studies Primary studies (6 references)

Loading references information
Some patients who have presented a thromboembolic event persist with a high risk of recurrence despite anticoagulant treatment. It has been suggested that adding an inferior vena cava filter may reduce this risk, but the clinical effects of this measure are not clear. To answer this question we searched in Epistemonikos database, which is maintained by screening multiple information sources. We identified three systematic reviews including four randomized trials answering this question. We extracted data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded there might be little or no difference on the occurrence of deep venous thrombosis by adding an inferior vena cava filter in anticoagulated patients, and it is not clear whether there are differences in the occurrence of pulmonary embolism or mortality because the certainty of evidence is very low.

Broad synthesis / Guideline

Unclassified

Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report.

Journal Chest
Year 2016
Liens Pubmed DOI

Cet article inclut 42 Primary studies Primary studies (42 references) 9 Systematic reviews Systematic reviews (9 references)

Loading references information
BACKGROUND: We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics. METHODS: We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence. RESULTS: For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C). CONCLUSIONS: Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.

Broad synthesis / Guideline

Unclassified

Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

Journal Chest
Year 2012
Liens Pubmed DOI PubMed Central

Cet article inclut 41 Primary studies Primary studies (41 references) 3 Systematic reviews Systematic reviews (3 references)

Loading references information
This article describes the pharmacology of approved parenteral anticoagulants. These include the indirect anticoagulants, unfractionated heparin (UFH), low-molecular-weight heparins (LMWHs), fondaparinux, and danaparoid, as well as the direct thrombin inhibitors hirudin, bivalirudin, and argatroban. UFH is a heterogeneous mixture of glycosaminoglycans that bind to antithrombin via a unique pentasaccharide sequence and catalyze the inactivation of thrombin, factor Xa, and other clotting enzymes. Heparin also binds to cells and plasma proteins other than antithrombin causing unpredictable pharmacokinetic and pharmacodynamic properties and triggering nonhemorrhagic side effects, such as heparin-induced thrombocytopenia (HIT) and osteoporosis. LMWHs have greater inhibitory activity against factor Xa than thrombin and exhibit less binding to cells and plasma proteins than heparin. Consequently, LMWH preparations have more predictable pharmacokinetic and pharmacodynamic properties, have a longer half-life than heparin, and are associated with a lower risk of nonhemorrhagic side effects. LMWHs can be administered once daily or bid by subcutaneous injection, without coagulation monitoring. Based on their greater convenience, LMWHs have replaced UFH for many clinical indications. Fondaparinux, a synthetic pentasaccharide, catalyzes the inhibition of factor Xa, but not thrombin, in an antithrombin-dependent fashion. Fondaparinux binds only to antithrombin. Therefore, fondaparinux-associated HIT or osteoporosis is unlikely to occur. Fondaparinux exhibits complete bioavailability when administered subcutaneously, has a longer half-life than LMWHs, and is given once daily by subcutaneous injection in fixed doses, without coagulation monitoring. Three additional parenteral direct thrombin inhibitors and danaparoid are approved as alternatives to heparin in patients with HIT.

Broad synthesis

Unclassified

Traitement antithrombotique pour la thromboembolie veineuse: Traitement antithrombotique et la prévention de la thrombose, 9ème édition: American College of Physicians Lignes directrices de pratique clinique fondées sur des preuves poitrine.

automatic
Journal Chest
Year 2012
Liens Pubmed DOI PubMed Central

Cet article inclut 75 Primary studies Primary studies (75 references) 10 Systematic reviews Systematic reviews (10 references)

Loading references information
CONTEXTE: Cet article porte sur le traitement de la maladie de TEV. MÉTHODES: Nous avons généré une forte (Grade 1) et la faiblesse des recommandations (Grade 2) Sur la base (Grade A), (Grade B), et les preuves de haute qualité de qualité moyenne à faible qualité (grade C). RÉSULTATS: Pour thrombose veineuse profonde aiguë ou d'embolie pulmonaire (EP), nous recommandons un traitement initial de l'anticoagulant par voie parentérale (Grade 1B) ou anticoagulation par rivaroxaban. Nous suggérons héparine de bas poids moléculaire (HBPM) ou le fondaparinux sur IV héparine non fractionnée (Grade 2C) ou sous-cutanée d'héparine non fractionnée (Grade 2B). Nous suggérons un traitement thrombolytique pour PE avec hypotension (Grade 2C). Pour TVP proximale ou une EP, nous recommandons un traitement de 3 mois sur des périodes plus courtes (Grade 1B). Pour une première thrombose veineuse profonde proximale ou EP qui est provoquée par une chirurgie ou par un facteur de risque transitoire non chirurgicale, nous recommandons 3 mois de traitement (1b année; Grade 2B si provoquée par un facteur de risque non chirurgicale et le risque faible ou modéré saignements), qui est sans provocation , nous vous proposons un traitement prolongé si le risque de saignement est faible ou modérée (Grade 2B) et nous recommandons 3 mois de traitement si le risque de saignement est élevé (Grade 1B), et qui est associée à un cancer actif, nous recommandons un traitement prolongé (Grade 1B, 2B grade en cas de risque élevé de saignement) et de proposer des HBPM sur les antagonistes de la vitamine K (Grade 2B). Nous suggérons des antagonistes de la vitamine K ou HBPM sur dabigatran ou rivaroxaban (Grade 2B.) Nous suggérons des bas de contention pour éviter le syndrome post-thrombotique (Grade 2B). Pour une thrombose veineuse superficielle, nous vous suggérons fondaparinux prophylactique à dose unique ou HBPM plus aucune anticoagulation (Grade 2B), et suggérons fondaparinux sur HBPM (Niveau 2C). CONCLUSION: Des recommandations fortes s'appliquent à la plupart des patients, alors que les recommandations faibles sont sensibles aux différences entre les patients, y compris leurs préférences.

Broad synthesis

Unclassified

Thromboembolism.

Journal Clinical evidence
Year 2011
Liens Pubmed PubMed Central

Cet article inclut 34 Primary studies Primary studies (34 references) 28 Systematic reviews Systematic reviews (28 references)

Loading references information
INTRODUCTION: Deep venous thrombosis (DVT) or pulmonary embolism may occur in almost 2 in 1000 people each year, with up to 25% of those having a recurrence. Around 5% to 15% of people with untreated DVT may die from pulmonary embolism. Risk factors for DVT include immobility, surgery (particularly orthopaedic), malignancy, pregnancy, older age, and inherited or acquired prothrombotic clotting disorders. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for proximal DVT? What are the effects of treatments for isolated calf DVT? What are the effects of treatments for pulmonary embolism? What are the effects of interventions on oral anticoagulation management in people with thromboembolism? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 45 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: anticoagulation; compression stockings; low molecular weight heparin (short and long term, once or twice daily, and home treatment); oral anticoagulants (short and long term, high intensity, abrupt discontinuation, and computerised decision support); prolonged duration of anticoagulation; thrombolysis; vena cava filters; and warfarin.

Broad synthesis

Unclassified

Questions contemporaines liées à la prévention et la gestion du syndrome post-thrombotique.

automatic
Journal The Annals of pharmacotherapy
Year 2009
Liens Pubmed DOI PubMed Central

Cet article inclut 48 Primary studies Primary studies (48 references) 25 Systematic reviews Systematic reviews (25 references)

Loading references information
OBJECTIF: Fournir un examen des données probantes et résumé clinique du syndrome post-thrombotique (PTS). SOURCES DES DONNÉES: Une revue de littérature a été réalisée via MEDLINE (1950-Juillet 1, 2009) et International Pharmaceutical Abstracts (1970-Juin 2009) des recherches en utilisant les termes syndrome post-thrombotique, syndrome post-phlébitique, une thrombose veineuse profonde, et des bas de compression. Synthèse des données: PTS est le mieux caractérisé comme un syndrome chronique des signes et des symptômes cliniques, y compris douleur, gonflement, paresthésies, et une ulcération dans le membre affecté suite à la thrombose veineuse profonde (TVP). Il survient chez jusqu'à la moitié des patients présentant une TVP symptomatique, généralement dans les 2 premières années. Bien que la physiopathologie de la PTS n'est pas bien comprise, un thrombus peut causer l'hypertension veineuse et insuffisance valvulaire traduisant par un oedème, une hypoxie tissulaire, et dans les cas graves, l'ulcération. Les facteurs de risque pour PTS comprennent récurrente TVP ipsilatérale, l'obésité et la mauvaise qualité du traitement anticoagulant. Diagnostic PTS est basée sur la présence de signes et symptômes typiques et peuvent être faites en utilisant l'un des nombreux systèmes de notation cliniques. Prévention de la PTS devrait se concentrer sur la prévention TVP et l'utilisation de bas de contention élastiques qui suivent la TVP, alors que la fibrinolyse est toujours sous enquête comme une méthode efficace pour la prévention PTS. Le traitement du SPT peuvent inclure soit pharmacologique ou mécanique modalités, bien qu'aucun de ces régimes a été rigoureusement testé. Les pharmaciens ont la possibilité de fournir plus complète de gestion antithrombotique en éduquant les patients et les fournisseurs sur le STP, en recommandant une thérapie appropriée de prévention, d'aider les patients à obtenir et à adhérer à cette thérapie, et aider les fournisseurs à la gestion de PTS. CONCLUSIONS: Les fournisseurs devraient être proactif dans la prévention de PTS, avec les pharmaciens jouent un rôle actif dans la prévention des TVP optimale, l'identification des patients à risque de PTS, et de conseiller et de diriger les thérapies préventives.