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DOI: 10.1055/s-2002-32317
Unresolved Issues in the Prevention and Treatment of Venous Thromboembolism
Publication History
Publication Date:
19 June 2002 (online)
ABSTRACT
Venous thromboembolism (VTE) is a major health problem. Anticoagulation can significantly decrease the morbidity and mortality associated with VTE. Heparin and coumarin derivatives have been the standard of care for the last 50 years, and the development of low-molecular-weight heparin preparations has significantly improved the prevention and treatment of venous thromboembolic disease. With these advances, investigators are now able to address some of the unresolved issues in antithrombotic therapy, including the search for the optimal antithrombotic agent in high-risk patients, the optimal timing of thromboprophylaxis initiation in the surgical population, and the duration of prophylaxis for the prevention of initial and recurrent VTE events. Clinical trials have begun to investigate many of these issues, and the resulting data have already contributed to improving the management of patients with a high risk of VTE.
KEYWORDS
Venous thromboembolism - prophylaxis - heparin - low-molecular-weight heparin - factor Xa inhibitors
REFERENCES
- 1 Heit J A, Melton III J L, Lohse C M. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc . 2001; 76 1102-1110
- 2 Moser K M, Fedullo P F, LitteJohn J K, Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA . 1994; 271 223-225
- 3 Heit J A, Silverstein M D, Mohr D N. Predictors of survival after deep vein thrombosis and pulmonary embolism. A population-based, cohort study. Arch Intern Med . 1999; 159 445-453
- 4 Carson J L, Kelley M A, Duff A. The clinical course of pulmonary embolism. N Engl J Med . 1992; 326 1240-1245
- 5 PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA . 1990; 263 2753-2759
- 6 Geerts W H, Heit J A, Clagett G P. Prevention of venous thromboembolism. Chest . 2001; 119(suppl) 132S-175S
- 7 Bauer K. Selective inhibition of coagulation factors: advancing antithrombotic therapy. Semin Thromb Hemost . 2002; 28(Suppl 2) 15-24
- 8 Koch A, Ziegler S, Breitschwerdt H, Victor N. Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis: meta-analysis based on original patient data. Thromb Res . 2001; 102 295-309
- 9 Rocha E, Martinez-González M A, Montes R, Panizo C. Do the low molecular weight heparins improve efficacy and safety of the treatment of deep venous thrombosis?. <~>A meta-analysis. Haematologica . 2000; 85 935-942
- 10 Leizorovicz A. Comparison of the efficacy and safety of low molecular weight heparins and unfractionated heparin in the initial treatment of deep venous thrombosis. An updated meta-analysis. Drugs . 1996; 52(Suppl 7) 30-37
- 11 van der Heijden F J, Prins M H, Büller H R. Low-molecular-weight heparins: are they interchangeable?. Haemostasis . 2000; 30(Suppl 2) 148-157
- 12 Heit J A, Silverstein M D, Mohr D N. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med . 2000; 160 809-815
- 13 Price D T, Ridker P M. Factor V Leiden mutation and the risks for thromboembolic disease: a clinical perspective. Ann Intern Med . 1997; 127 895-903
- 14 Weitz J I, Hirsh J. New anticoagulant drugs. Chest . 2001; 119(Suppl) 95S-107S
- 15 Lee A, Agnelli G, Büller H. Dose-response study of recombinant factor VIIa/tissue factor inhibitor recombinant nematode anticoagulant protein c2 in prevention of postoperative venous thromboembolism in patients undergoing total knee replacement. Circulation . 2001; 104 74-78
- 16 Heit J A, Colwell C W, Francis C W. Comparison of the oral direct thrombin inhibitor ximelagatran with enoxaparin as prophylaxis against venous thromboembolism after total knee replacement. A phase 2 dose-finding study. Arch Intern Med . 2001; 161 2215-2221
- 17 Eriksson B I, Arfwidsson A-C, Frison L. A dose-ranging study of the oral direct thrombin inhibitor, ximelagatran, and its subcutaneous form, melagatran, compared with dalteparin in the prophylaxis of thromboembolism after hip or knee replacement: METHRO I. Thromb Haemost . 2002; 87 231-237
- 18 Eriksson B I, Ögren M, Agnelli G. The oral direct thrombin inhibitor ximelagatran (pINN, formerly H 376/95) and its subcutaneous form melagatran compared with enoxaparin as thromboprophylaxis after total hip or total knee replacement [abstract OC1638]. Thromb Haemost 2001; July(Suppl). Available on CD-ROM published by Excerpta Medica Medical Communications
- 19 Francis C W, Davidson B L, Berkowitz S D. Randomized, double-blind, comparative study of ximelagatran (pINN, formerly H 376/95), an oral direct thrombin inhibitor, and warfarin to prevent venous thromboembolism (VTE) after total knee arthroplasty (TKA) [abstract OC44]. Thromb Haemost 2001;July(Suppl). Available on CD-ROM published by Excerpta Medica Medical Communications
- 20 Eriksson B I, Lindbratt S, Kälebo P. Methro II: dose-response study of the novel oral, direct thrombin inhibitor, H 376/95 and its subcutaneous formulation melagatran, compared with dalteparin as thromboembolic prophylaxis after total hip or total knee replacement [abstract 38]. Haemostasis . 2000; 30(Suppl 1) 20-21
- 21 Donat F, Duret J P, Santoni A. Pharmacokinetics of Org31540/SR90107A in young and elderly healthy subjects: a highly favourable pharmacokinetic profile [abstract P3094]. Thromb Haemost 2001;July(Suppl). Available on CD-ROM published by Excerpta Medica Medical Communications
- 22 Turpie A GG, Bauer K A, Eriksson B I, Lassen M R, for the PENTATHLON 2000 Study Steering Committee. Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hip-replacement surgery: a randomised double-blind trial. Lancet . 2002; 359 1721-26
- 23 Lassen M R, Bauer K A, Eriksson B I, Turpie A GG, for the European Pentasaccharide Hip Elective Surgery Study (EPHESUS) Steering Committee. Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison. Lancet . 2002; 359 1715-20
- 24 Eriksson B I, Bauer K A, Lassen M R, Turpie A GG, for the Steering Committee of the Pentasaccharide in Hip-Fracture Surgery Study. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med . 2001; 345 1298-1304
- 25 Bauer K A, Eriksson B I, Lassen M R, Turpie A GG, for the Steering Committee of the Pentasaccharide in Major Knee Surgery Study. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med . 2001; 345 1305-1310
- 26 Turpie A GG. Overview of the clinical results of pentasaccharide in major orthopedic surgery. Haematologica . 2001; 86(Suppl 11) 59-62
- 27 Simoons M L. The PENTUA study: double-blind dose-ranging study of fondaparinux (pentasaccharide) in unstable angina. 2001. Available at: http://www.sessionsonline.org/ Html src/summary.asp?styId=32&uid=&ld=11/15/01. Accessed April 18, 2002
- 28 Coussement P K, Bassand J-P, Convens C. A synthetic factor-Xa inhibitor (ORG31540/SR9017A) as an adjunct to fibrinolysis in acute myocardial infarction. The PENTA-LYSE study. Eur Heart J . 2001; 22 1716-1724
- 29 The REMBRANDT Investigators. Treatment of proximal deep vein thrombosis with a novel synthetic compound (SR90107A/ORG31540) with pure anti-factor Xa activity: a phase II evaluation. Circulation . 2000; 102 2726-2731
- 30 Hull R D, Brant R F, Pineo G F. Preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement. Arch Intern Med . 1999; 159 137-141
- 31 Agnelli G, Mancini G B, Biagini D. The rationale for long-term prophylaxis of venous thromboembolism. Orthopedics . 2000; 23(Suppl 6) s643-s646
- 32 Bergqvist D, Benoni G, Björgell O. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med . 1996; 335 696-700
- 33 Planes A, Vochelle N, Darmon J-Y. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet . 1996; 348 224-228
- 34 Dahl O E, Andreassen G, Aspelin T. Prolonged thromboprophylaxis following hip replacement surgery-results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin). Thromb Haemost . 1997; 77 26-31
- 35 Lassen M R, Borris L C, Anderson B S. Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty-the Danish Prolonged Prophylaxis (DaPP) Study. Thromb Res . 1998; 89 281-287
- 36 Hull R D, Pineo G F, Francis C. Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients. A double-blind, randomized comparison. Arch Intern Med . 2000; 160 2208-2215
- 37 Comp P C, Spiro T E, Friedman R J. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. J Bone Joint Surg Am . 2001; 83 336-345
- 38 Hull R D, Pineo G F, Stein P D. Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann Intern Med . 2001; 135 858-869
- 39 Cohen A T, Bailey C S, Alikhan R, Cooper D J. Extended thromboprophylaxis with low molecular weight heparin reduces symptomatic venous thromboembolism following lower limb arthroplasty-a meta-analysis. Thromb Haemost . 2001; 85 940-941
- 40 Heit J A, Elliott C G, Trowbridge A A. Ardeparin sodium for extended out-of-hospital prophylaxis against venous thromboembolism after total hip or knee replacement: a randomized, double-blind, placebo-controlled trial. Ann Intern Med . 2000; 132 853-861
- 41 Eikelboom J W, Quinlan D J, Douketis J D. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet . 2001; 358 9-15
- 42 Agnelli G, Taliani M R, Verso M. Building effective prophylaxis of deep vein thrombosis in the outpatient setting. Blood Coagul Fibrinolysis . 1999; 10(Suppl 2) S29-S35
- 43 Agnelli G, Prandoni P, Santamaria M G. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med . 2001; 345 165-169
- 44 Hyers T M, Agnelli G, Hull R D. Antithrombotic therapy for venous thromboembolic disease. Chest . 2001; 119 (Suppl 1) 176S-193S
- 45 Kearon C, Gent M, Hirsh J. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med . 1999; 340 901-907