Proximal DVT may cause fatal or nonfatal pulmonary embolism, recurrent venous thrombosis, and postthrombotic syndrome. Proximal extension develops in 40 to 50 percent of persons with symptomatic calf DVT. The rate of fatal recurrent venous thromboembolism after anticoagulation has been estimated at 0.3 per 100 patient-years. The annual recurrence rate of symptomatic calf DVT in persons without recent surgery is more than 25 percent. One postmortem study estimated that 600,000 persons develop pulmonary embolism each year in the United States, of whom 60,000 die as a result. Ethnic origin may affect incidence, with one study reporting increased incidence in black persons. A further Australian study found a standardized annual incidence per 1,000 residents of 0.57 (95% CI, 0.47 to 0.67) for all venous thromboembolism, 0.35 (95% CI, 0.26 to 0.44) for DVT, and 0.21 (95% CI, 0.14 to 0.28) for pulmonary embolism. A more recently published retrospective study from Norway found the incidence of DVT between 19 to be 0.93 per 1,000 person-years (95% confidence interval, 0.85 to 1.02 per 1,000 person-years), and of pulmonary embolism to be 0.50 per 1,000 person-years (95% CI, 0.44 to 0.56 per 1,000 person-years). A prospective Scandinavian study found an annual incidence of 1.6 to 1.8 per 1,000 persons in the general population. We found no reliable study of the incidence or prevalence of DVT or pulmonary embolism in the United Kingdom. Dosing of warfarin and frequency of testing are also managed by the patient, with support from the health professional clinically responsible according to an agreed contract. Self-management is where the patient is responsible for testing his or her international normalized ratio at home using capillary sampling and a point-of-care device. Dosing of warfarin and frequency of testing are advised by the health professional clinically responsible for the patient's management. Self-testing is where the patient is responsible for testing his or her international normalized ratio at home using capillary sampling and a point-of-care device. Extension refers to a radiologically confirmed, new, constant, symptomatic intraluminal filling defect extending from an existing thrombosis. Recurrence refers to symptomatic deterioration due to a further (radiologically confirmed) thrombosis, after a previously confirmed thromboembolic event, where there had been an initial partial or total symptomatic improvement. Self-testing and self-management of oral anticoagulation What are the effects of interventions on oral anticoagulation management in persons with thromboembolism?Ĭomputerized decision support in oral anticoagulation (increased time spent in target international normalized ratio range) High-intensity anticoagulation (extrapolated data from persons with proximal DVT) LMWH (no clear evidence of a difference in mortality, new episodes of thromboembolism, or in risk of major hemorrhage compared with unfractionated heparin) What are the effects of treatments for pulmonary embolism? Warfarin (reduced rate of proximal extension compared with no further treatment in persons who had received initial heparin and wore compression stockings) What are the effects of treatments for isolated calf DVT? Vena cava filters (reduce short-term rate of pulmonary embolism, but may increase the long-term risk of recurrent DVT)Ībrupt discontinuation of oral anticoagulation long-term anticoagulation (both showed similar levels of benefits but with important adverse effects) LMWH (reduced mortality, recurrence, and risk of major hemorrhage compared with unfractionated heparin) What are the effects of treatments for proximal DVT? Vena cava filters reduce the short-term rate of pulmonary embolism, but they may increase the long-term risk of recurrent DVT.Įlastic compression stockings reduce the incidence of postthrombotic syndrome after DVT compared with placebo or no treatment. Home treatment may be more effective than hospital-based treatment at preventing recurrence, and equally effective at reducing mortality. We do not know whether once-daily LMWH is as effective as twice-daily administration at preventing recurrence. We do not know how effective tapering of oral anticoagulant agents is compared with stopping abruptly. Low-molecular-weight heparin (LMWH) is more effective than unfractionated heparin, and may be as effective as oral anticoagulants, although all are associated with some adverse effects. Both approaches increase the risk of major bleeding. In persons with proximal DVT or pulmonary embolism, long-term anticoagulation reduces the risk of recurrence, but high-intensity treatment has shown no benefit.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |