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Sylvia Haas Walter Ageno Jeffrey I. Weitz Samuel Z. Goldhaber Alexander G. G. Turpie Shinya Goto Pantep Angchaisuksiri Joern Dalsgaard Nielsen Gloria Kayani Audrey Zaghdoun Alfredo E. Farjat Sebastian Schellong Henri Bounameaux Lorenzo G. Mantovani Paolo Prandoni Ajay K. Kakkar 《Journal of thrombosis and haemostasis》2019,17(10):1694-1706
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Michota FA 《Cleveland Clinic journal of medicine》2006,73(Z1):S88-S94
Hospital strategies to prevent VTE are important to reduce acute morbidity and mortality as well as the long-term consequences caused by venous stasis syndrome. Patients at low risk (eg, those who are ambulatory or undergoing a same-day procedure) or who are at high risk for bleeding (including those with severe renal impairment) are candidates for nonpharmacologic strategies for thromboembolic prophylaxis. Mechanical devices are effective if used appropriately, but compliance is a challenge. Patients who require a hospital stay of more than a day or two should receive a medication-based strategy, preferably using LMWH or fondaparinux. Patients undergoing hip replacement should receive extended prophylaxis with LMWH. 相似文献
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A. A. KHORANA C. O’CONNELL G. AGNELLI H. A. LIEBMAN A. Y. Y. LEE On Behalf of the Subcommittee on Hemostasis Malignancy of the SSC of the ISTH 《Journal of thrombosis and haemostasis》2012,10(12):2602-2604
Khorana AA, O’Connell C, Agnelli G, Liebman HA, Lee AYY, On Behalf of the Subcommittee on Hemostasis and Malignancy of the SSC of the ISTH. Incidental venous thromboembolism in oncology patients. J Thromb Haemost 2012; 10: 2602–4. 相似文献
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B. Ünlü N. van Es W. Arindrarto S. M. Kiełbasa H. Mei J. Westerga S. Middeldorp P. J. K. Kuppen J.M.M.B. Otten S. Cannegieter H. H. Versteeg 《Journal of thrombosis and haemostasis》2018,16(2):293-302
Essentials
- The underlying pathophysiological mechanisms behind cancer‐associated thrombosis are unknown.
- We compared expression profiles in tumor cells from patients with and without thrombosis.
- Tumors from patients with thrombosis showed significant differential gene expression profiles.
- Patients with thrombosis had a proinflammatory status and increased fibrin levels in the tumor.
Summary
Background
Venous thromboembolism (VTE) is a frequent complication in patients with cancer, and is associated with significant morbidity and mortality. However, the mechanisms behind cancer‐associated thrombosis are still incompletely understood.Objectives
To identify novel genes that are associated with VTE in patients with colorectal cancer (CRC).Methods
Twelve CRC patients with VTE were age‐matched and sex‐matched to 12 CRC patients without VTE. Tumor cells were isolated from surgical samples with laser capture microdissection approaches, and mRNA profiles were measured with next‐generation RNA sequencing.Results
This approach led to the identification of new genes and pathways that might contribute to VTE in CRC patients. Application of ingenuity pathway analysis indicated significant links with inflammation, the methionine degradation pathway, and increased platelet function, which are all key processes in thrombus formation. Tumor samples of patients with VTE had a proinflammatory status and contained higher levels of fibrin and fibrin degradation products than samples of those without VTE.Conclusion
This case–control study provides a proof‐of‐principle that tumor gene expression can discriminate between cancer patients with low and high risks of VTE. These findings may help to further unravel the pathogenesis of cancer‐related VTE. The identified genes could potentially be used as candidate biomarkers to select high‐risk CRC patients for thromboprophylaxis.7.
Tarek Nafee C. Michael Gibson Megan K. Yee Fahad Alkhalfan Gerald Chi Ryan Travis 《Expert review of cardiovascular therapy》2013,11(11):845-855
ABSTRACTIntroduction: Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial evaluated the efficacy and safety of extended duration betrixaban compared to standard duration enoxaparin in acutely ill hospitalized patients.Areas covered: This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients. This article provides a consolidated summary of the primary APEX study findings as well as prespecified and exploratory substudies. This article also provides a review of the results of studies in which other direct factor Xa inhibitors have been evaluated in an extended duration regimen in this patient population.Expert commentary: While previous agents have demonstrated that extended duration VTE prophylaxis can be efficacious, betrixaban is the first agent to demonstrate efficacy without an increase in major bleeding. The totality of the data from the APEX trial supports extended duration betrixaban for VTE prophylaxis in the acute medically ill patient population. As such, betrixaban has been approved in the USA for extended VTE prophylaxis in at-risk acute medically ill patients. 相似文献
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Aronow WS 《Comprehensive therapy》2008,34(1):2-9
The rationale for thromboprophylaxis is based on the high prevalence of venous thromboembolism (VTE). Use of effective methods of prophylaxis is more cost-effective and is safer than selective, intensive screening for VTE. These therapeutic options will be discussed. 相似文献
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BACKGROUND: While extensive data support the clinical benefit and cost-effectiveness of routine thromboprophylaxis in surgical patients, the use of this approach in medical patients has been controversial. However, recent data, mainly from the MEDENOX trial, support routine thromboprophylaxis in acutely ill medical patients. AIM: To determine attitudes towards VTE prevention in such patients, in departments of internal medicine in Israel. DESIGN: Questionnaire-based survey. METHODS: A questionnaire regarding aspects of VTE prophylaxis was mailed to all heads of internal medicine departments in Israel (n = 90). The questionnaire also included data concerning VTE prevention measures in specific acute medical illnesses, based on the MEDENOX study population. RESULTS: Fifty-eight (64%) departments returned the questionnaire. Forty-seven (81%) of them considered VTE a clinical problem in their departments, but only 37 (63%) had a routine VTE prevention policy. The most frequently used modality for VTE prophylaxis was low-molecular-weight heparin. There was little agreement concerning the exact indications or risk factors in which VTE prophylaxis measures should be used, except the combination of acute medical disabling illness and previous VTE. DISCUSSION: The results emphasize the need for detailed guidelines and risk assessment models for VTE prevention treatments in acutely ill medical patients, as well as better education for physicians. 相似文献
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目的 探讨乳腺癌患者发生静脉血栓栓塞症的危险因素.方法 回顾性分析自2014年7月至2020年3月新汶矿业集团莱芜中心医院收治的90例女性乳腺癌患者临床资料,根据静脉血栓栓塞症发生情况分为未发生静脉血栓栓塞症的A组(n=60)与发生静脉血栓栓塞症的B组(n=30).记录两组患者的年龄、体质量指数、糖尿病病史、冠心病病史... 相似文献
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672例静脉血栓栓塞症相关危险因素分析 总被引:7,自引:0,他引:7
目的 分析静脉血栓栓塞症(VrrE)住院患者的患病情况、临床特征和危险因素。方法 回顾性分析北京协和医院1994年至2004年住院VTE病例的患病趋势、人口学特点、获得性及遗传性危险因素。结果 共收集VTE患者672例,男:女=1.2:1,中位年龄53(14—92)岁。初发患者580例(86.3%),发病高峰年龄男性患者为40~50岁,女性为50-60岁。主要获得性危险因素有抗磷脂抗体阳性(32.0%)、外伤和(或)手术(31.1%)、肿瘤(17.1%)。其中具有多种获得性危险因素者占35.7%。94例患者在抗凝治疗前取外周血检测了蛋白C(PC)、蛋白S(PS)和抗凝血酶(AT)活性。抗凝蛋白总缺陷率为44.7%,以PC缺乏以及PC与AT联合缺乏为主,分别占13.8%和10.6%。同时具有遗传和获得性危险因素者占31.6%。结论 研究结果显示综合医院的住院VTE病例数呈逐年上升趋势,男性VTE患者的初发年龄较女性提早约10年。主要获得性危险因素为抗磷脂抗体阳性、外伤或手术和肿瘤,而遗传性危险因素则以PC缺乏和PC与AT联合缺乏为主。多种危险因素并存是促发VTE的重要原因。 相似文献
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As the largest professional group involved in direct clinical care, nurses have a vital role to play in venous thromboembolism prevention. This article describes the condition and its implications for patients. It discusses how nurses can reduce the risk of harm to patients through risk assessment and thromboprophylaxis, and by educating patients. 相似文献
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Omega‐3 fatty acids predict recurrent venous thromboembolism or total mortality in elderly patients with acute venous thromboembolism
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M. F. Reiner S. Stivala A. Limacher N. R. Bonetti M. Méan M. Egloff N. Rodondi D. Aujesky C. von Schacky T. F. Lüscher G. G. Camici J. H. Beer 《Journal of thrombosis and haemostasis》2017,15(1):47-56
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目的探讨老年心房颤动和血栓疾病华法林抗凝治疗。方法总结分析21例(75.7±5.9)岁(64-85岁)的心房颤动(15例)、深静脉血栓(5例)和肺动脉栓塞(1例)患者华法林抗凝治疗的临床资料。华法林起始剂量2.5mg/d,增减0.3125mg-0.625mg/d。INR≥1.8为达标,维持在1.8-2.5,≤3.0。结果(1)19例在服药(10.0±6.0)d、中位数7dlNR达标,2例服药1月、5mg/d≥1wINR不达标而停药。(2)华法林达标时日剂量(2.928±0.591)mg/a高于初始和维持日剂量(2.557±0.681)mg/d,统计学差异显著(P〈0.01,P=0.01)。(3)INR达标时平均2.247±0.488,维持用药期间平均2.454±0.634。(4)治疗期间无INR延长相关的出血事件。结论2.5mg/d的华法林初始剂量及0.3125mg-0.625mg/d的增量调整可使老年房颤和血栓性疾病患者INR在1-3周内平稳扶标,及时调整剂量控制INR存1.8-3.0安全有效。 相似文献
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目的 观察静脉血栓栓塞症(venous thromboembolism,VTE)患者内皮功能障碍标志物的变化,探讨内皮功能障碍导致机体凝血-抗凝血制约关系的失衡在VTE发生发展中的作用.方法 选取120例确诊的VTE患者和50例健康人为研究对象,其中深静脉血栓形成(deep venous thrombosis,DVT)患者84例,DVT合并肺血栓栓塞症(pulmonary thromboembolism,PTE)患者36例,采用SYSMEX CA-7000型血液凝固仪免疫法测定血管性血友病因子(von Willebrand Factor,vWF)和D二聚体(D-dimer)水平;发色底物法测定抗凝血酶活性(antithrombin,AT)、蛋白C活性(protein C,PC)、纤溶酶原激活物抑制因子1(plasminogen activator inhibitor-1,PAl-1)和组织型纤溶酶原激活物(tissue plasminogen activator,t-PA);凝固法测定凝血因子V活性(factorV,FV)和凝血因子Ⅷ活性(factorⅧ,FⅧ).结果 VTE患者VWF、PAI-1、D-dimer水平高于对照组,vWF(184.64±27.21)%vs(97.95±15.89)%(P<0.01),PAI-1(2.61±0.79)AU/ml vs(0.55±0.28)AU/ml(P<0.01),D-dimer(2 501.95±942.91)μg/L vs(204.43±51.24)μg/L(P<0.01);AT、PC、t-PA水平低于对照组,AT(70.03±13.76)%vs(99.57±12.36)%(P<0.01),PC(72.76±18.51)%vs(17.64±24.38)%(P<0.01),t-PA(0.23±0.04)U/ml vs(0.41±0.07)U/ml(P<0.01);FV(97.28±17.13)%vs(96.45±16.04)%(P>0.05),FVl(101.00±17.57)%vs(100.48±17.38)%(P>0.05).DVT组与DVT合并PTE组比较VWF、FⅧ、AT差异有统计学意义,VWF(173.90±25.03)%vs(189.23±26.94)%(P<0.01),FⅧ(95.12±16.02)%vs(102.78±17.53)%(P<0.05),AT(72.65±13.55)%vs(63.92±12.39)%(P<0.01);而F V、PC、PAI-1、t-PA、D-dimer差异无统计学意义,F V(94.73±18.89)%vs(98.37±16.32)%(P>0.05),PC(74.03±18.83)%vs(69.79±17.61)%(P>0.05);PAI-1(2.56±0.28)AU/ml vs(2.62±0.78)AU/ml(P>0.05),t-PA(0.23±0.04)U/ml vs(0.23±0.03)U/ml(P>0.05),D-dimer(2 458.5±809.31)μg/L vs(2 603.2±1 206.04)μg/L(P 2>0.05).结论 内皮系统的损伤是VTE的临床特征之一,内皮功能障碍在VTE发生发展中起重要作用. 相似文献
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Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism (PE), is a common complication of cancer and an important cause of preventable mortality in people with cancer. Because VTE can be clinically silent, fatal PE generally occurs without warning, and preventive measures are, therefore, necessary in high-risk patients. Clinical guidelines recommend the use of low-molecular-weight heparins in the treatment and prevention of VTE in patients with cancer, in addition to non-pharmacological interventions aimed at reducing thrombotic risk. Nurses have an important role in helping to identify patients at risk of developing VTE, and in the implementation of preventive or therapeutic regimens, and monitoring the development of complications. Furthermore, nurses are in an ideal position to educate patients on the importance of preventive measures and to help ensure compliance with thromboprophylactic interventions. 相似文献
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《Klinicheskaia meditsina》2011,89(6):4-8
At present, almost 25% of the world population suffer from venous thromboembolism (VTE). This condition is currently regarded as a continuum of thromboembolism of pulmonary artery (TEPA) and venous thromboses including superficial venous thromboses. These diseases are not infrequently concomitant and asymptomatic. Up to 75% of the cases of venous thrombosis in the lower extremities are associated with latent TEPA and 80% of the cases of pulmonory embolism with asymptomatic venous thrombosis. The mortality rate from TEPA is estimated to be one person per 1,000. The data of autopsies indicate that 50-80% of the TEPA cases are not diagnosed at all. As many as 300 subjects of 100,000 suffer trophic ulcers in the lower extremities as a result of previous venous thrombosis. Prophylaxis is supposed to be the principal means of VTE control. Chronic lung diseases are the leading risk factors of VTE. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. It is expected to become the third major cause of death by 2020. Hospitalization of COPD patients in therapeutic clinics increases the risk of VTE by 7.98 times. Prophylaxis of VTE in COPD patients may reduce the frequency of exacerbation and hospitalization and increase life expectancy. 相似文献