Long-term Management of Venous Thromboembolism A 61-Year-Old Woman With Unprovoked Venous Thromboembolism

被引:5
|
作者
Bauer, Kenneth A. [1 ,2 ,3 ]
机构
[1] Beth Israel Deaconess Med Ctr, Boston, MA 02492 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] VA Boston Healthcare Syst, Hematol Sect, Boston, MA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2011年 / 305卷 / 13期
关键词
DEEP-VEIN-THROMBOSIS; FACTOR-V-LEIDEN; ORAL ANTICOAGULANT-THERAPY; LOW-INTENSITY WARFARIN; COAGULATION-FACTOR-V; D-DIMER; PULMONARY-EMBOLISM; RISK-FACTORS; FACTOR-VIII; HETEROZYGOUS CARRIERS;
D O I
10.1001/jama.2011.361
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Numerous randomized clinical trials have compared various durations of anticoagulant therapy with a vitamin K antagonist (ie, warfarin) for an initial episode of venous thromboembolism (VTE). Despite major advances in understanding the pathophysiology of thrombosis and its genetic basis, clinical risk factors at presentation have emerged as the primary determinant of recurrence risk. Following a minimum of 3 months of anticoagulant therapy, patients with VTE in association with transient risk factors (eg, major surgery, trauma, pregnancy) have a low annual recurrence risk, while patients without identifiable provocative risk factors have a recurrence risk of approximately 25% at 4 years with the highest annual rates occurring in the first 2 years. Extending warfarin therapy is highly effective in preventing recurrences but is associated with increased rates of major and minor bleeding. Clinical decision making therefore requires individualized assessment of recurrence and bleeding risk, coupled with patient preference. After 3 months of anticoagulant therapy for a first episode of unprovoked VTE, male sex, age older than 65 years, and an elevated D-dimer level 1 month after discontinuing anticoagulant therapy are useful parameters in identifying patients with an increased recurrence risk. The case of Ms W, a woman with unprovoked venous thromboembolism and hemorrhagic event while receiving anticoagulation, is used to illustrate clinical decision making to determine ongoing treatment. JAMA. 2011;305(13):1336-1345 www.jama.com
引用
收藏
页码:1336 / 1345
页数:10
相关论文
共 50 条
  • [21] Unprovoked venous thromboembolism: assess for cancer
    Shaboodien, Roekshana
    Stansby, Gerard
    Hunt, Beverley J.
    Agarwal, Roshan
    LANCET ONCOLOGY, 2012, 13 (10): : 973 - 974
  • [22] Cancer Screening in Unprovoked Venous Thromboembolism
    Piccioli, Andrea
    Bernardi, Enrico
    Prandoni, Paolo
    NEW ENGLAND JOURNAL OF MEDICINE, 2015, 373 (25): : 2473 - 2473
  • [23] Screening for cancer in unprovoked venous thromboembolism
    Shivji, Selma
    Carrier, Marc
    HEMASPHERE, 2019, 3 : 22 - 23
  • [24] Recurrence after unprovoked venous thromboembolism
    Spencer, Frederick A.
    Ginberg, Jeffrey S.
    BRITISH MEDICAL JOURNAL, 2011, 342
  • [25] Extended anticoagulation for unprovoked venous thromboembolism
    Castellucci, Lana A.
    de Wit, Kerstin
    Garcia, David
    Ortel, Thomas L.
    Le Gal, Gregoire
    RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS, 2018, 2 (03) : 529 - 534
  • [26] Management of venous thromboembolism for older adults in long-term care facilities
    Choi, Myunghan
    Hector, Melvin
    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, 2012, 24 (06): : 335 - 344
  • [27] Fondaparinux in the initial and long-term treatment of venous thromboembolism
    Pesavento, Raffaele
    Amitrano, Maria
    Trujillo-Santos, Javier
    Di Micco, Pierpaolo
    Mangiacapra, Sara
    Lopez-Jimenez, Luciano
    Falga, Conxita
    Garcia-Bragado, Fernando
    Piovella, Chiara
    Prandoni, Paolo
    Monreal, Manuel
    THROMBOSIS RESEARCH, 2015, 135 (02) : 311 - 317
  • [28] Long-term survival of patients with a history of venous thromboembolism
    Reitter, Sylvia Elisabeth
    Waldhoer, Thomas
    Mayerhofer, Michaela
    Eigenbauer, Ernst
    Ay, Cihan
    Kyrle, Paul Alexander
    Pabinger, Ingrid
    ANNALS OF HEMATOLOGY, 2011, 90 (05) : 585 - 594
  • [29] Long-term survival of patients with a history of venous thromboembolism
    Sylvia Elisabeth Reitter
    Thomas Waldhoer
    Michaela Mayerhofer
    Ernst Eigenbauer
    Cihan Ay
    Paul Alexander Kyrle
    Ingrid Pabinger
    Annals of Hematology, 2011, 90 : 585 - 594
  • [30] Long-term Risk of Venous Thromboembolism After Stroke
    Murthy, Santosh B.
    Merkler, Alexander E.
    Gialdini, Gino
    Chatterjee, Abhinaba
    Iadecola, Costantino
    Navi, Babak B.
    Kamel, Hooman
    STROKE, 2017, 48