Treatment of venous thromboembolism - effects of different therapeutic strategies on bleeding and recurrence rates and considerations for future anticoagulant management

被引:9
作者
Bastian Hass
Jayne Pooley
Adrian E Harrington
Andreas Clemens
Martin Feuring
机构
[1] Boehringer Ingelheim GmbH, 55216, Ingelheim am Rhein
[2] United BioSource Corporation, River House, London, SW18 1NN
[3] Boehringer Ingelheim Pharma GmbH and Co. KG, 55216, Ingelheim am Rhein
[4] Center of Thrombosis and Hemostasis, Johannes Gutenberg University, Medical Center, Mainz
关键词
Anticoagulants; Bleeding; Heparin; Recurrence; Venous thromboembolism; Vitamin K antagonists;
D O I
10.1186/1477-9560-10-24
中图分类号
学科分类号
摘要
Effective treatment of venous thromboembolism (VTE) strikes a balance between prevention of recurrence and bleeding complications. The current standard of care is heparin followed by a vitamin K antagonist such as warfarin. However, this option is not without its limitations, as the anticoagulant effect of warfarin is associated with high inter- and intra-patient variability and patients must be regularly monitored to ensure that anticoagulation is within the narrow target therapeutic range. Several novel oral anticoagulant agents are in the advanced stages of development for VTE treatment, some of which are given after an initial period of heparin treatment, in line with current practice, while others switch from high to low doses after the initial phase of treatment. In this review we assess the critical considerations for treating VTE in light of emerging clinical data for new oral agents and discuss the merits of novel treatment regimens for patients who have experienced an episode of deep vein thrombosis or pulmonary embolism. © 2012 Hass et al.; licensee BioMed Central Ltd.
引用
收藏
相关论文
共 69 条
  • [1] Kearon C., Kahn S.R., Agnelli G., Goldhaber S., Raskob G.E., Comerota A.J., Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), Chest, 133, (2008)
  • [2] Stein P.D., Hull R.D., Matta F., Yaekoub A.Y., Anticoagulant therapy for acute venous thromboembolism: what we think we know and what the data show for the timing of recurrent events, Clin Appl Thromb Hemost, 15, pp. 609-612, (2009)
  • [3] Hansson P.O., Sorbo J., Eriksson H., Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors, Arch Intern Med, 160, pp. 769-774, (2000)
  • [4] Heit J.A., Mohr D.N., Silverstein M.D., Petterson T.M., O'Fallon W.M., Melton L.J., III: Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study, Arch Intern Med, 160, pp. 761-768, (2000)
  • [5] Prandoni P., Villalta S., Bagatella P., Rossi L., Marchiori A., Piccioli A., Et al., The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients, Haematologica, 82, pp. 423-428, (1997)
  • [6] Douketis J.D., Foster G.A., Crowther M.A., Prins M.H., Ginsberg J.S., Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy, Arch Intern Med, 160, pp. 3431-3436, (2000)
  • [7] van Dongen C.J., Vink R., Hutten B.A., Buller H.R., Prins M.H., The incidence of recurrent venous thromboembolism after treatment with vitamin K antagonists in relation to time since first event: a meta-analysis, Arch Intern Med, 163, pp. 1285-1293, (2003)
  • [8] Douketis J., Tosetto A., Marcucci M., Baglin T., Cosmi B., Cushman M., Et al., Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis, Br Med J, 342, (2012)
  • [9] Douketis J.D., Kearon C., Bates S., Duku E.K., Ginsberg J.S., Risk of fatal pulmonary embolism in patients with treated venous thromboembolism, JAMA, 279, pp. 458-462, (1998)
  • [10] Spencer F.A., Gore J.M., Lessard D., Douketis J.D., Emery C., Goldberg R.J., Patient outcomes after deep vein thrombosis and pulmonary embolism: the Worcester Venous Thromboembolism Study, Arch Intern Med, 168, pp. 425-430, (2008)