Deep venous thrombosis and pulmonary embolism

  • Steven R. Deitcher
  • Teresa L. Carman
Article

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References and Recommended Reading

  1. 1.
    Goldhaber S, Visani L, De Rosa M: Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999, 353:1386–1389.PubMedCrossRefGoogle Scholar
  2. 2.
    Hull RD, Raskob GE, Hirsh J, et al.: Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis. N Engl J Med 1986, 315:1109–1114.PubMedCrossRefGoogle Scholar
  3. 3.
    Prandoni P, Lensing AWA, Cogo A, et al.: The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996, 125:1–7.PubMedGoogle Scholar
  4. 4.
    Schulman S, Rhedin A-S, Lindmaker P, et al.: A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 1995, 332:1661–1665.PubMedCrossRefGoogle Scholar
  5. 5.
    Decousus H, Leizorovicz A, Parent F, et al.: A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 1998, 338:409–415. This is the only randomized trial of IVC filter use in patients with DVT. Patients were randomized to IVC filter placement plus anticoagulation or to anticoagulation alone. The results demonstrated effective prevention of PE (1.1% vs 4.8%) at 12 days of follow-up. However, there was no difference in the rate of symptomatic PE at 2 years of follow-up (3.4% vs 6.3%) but there was a significantly increased incidence of recurrent DVT (20.8% vs 11.6%).PubMedCrossRefGoogle Scholar
  6. 6.
    Dolovich LR, Ginsberg JS, Douketis JD, et al.: A metaanalysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism. Arch Intern Med 2000, 160:181–188. The most recent meta-analysis to evaluate the data comparing the outcomes of DVT treatment with LMWH compared with UFH. Because few data are available for each individual LMWH, results of different LMWHs are pooled to generate the analysis. Equivalence is demonstrated between LMWH and UFH with respect to DVT recurrence, PE, and safety with respect to major bleeding, minor bleeding, and thrombocytopenia. A survival advantage, mostly attributable to a single included study, in favor of LMWH was observed.PubMedCrossRefGoogle Scholar
  7. 7.
    Levine M, Gent M, Hirsh J, et al.: A comparison of lowmolecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996, 334:677–681.PubMedCrossRefGoogle Scholar
  8. 8.
    Hirsh J, Warkentin TE, Shaughnessy SG, et al.: Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy and safety. Chest 2001, 119:64S-94S. The authors provide a review of UFH and LMWH with a focus on pharmacology and pharmacokinetics. Information is provided regarding the dosing, monitoring, and safety of these agents for prophylaxis of VTE, treatment of VTE, and use in cardiac disease.PubMedCrossRefGoogle Scholar
  9. 9.
    Gould MK, Dembitzer AD, Doyle RL, et al.: Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep vein thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med 1999, 130:800–809.PubMedGoogle Scholar
  10. 10.
    Kearon C, Gent M, Hirsh J, et al.: Extended anticoagulation prevented recurrence after a first episode of idiopathic venous thromboembolism. N Engl J Med 1999, 340:901–907.PubMedCrossRefGoogle Scholar
  11. 11.
    Simonneau G, Sors H, Charbonnier B, et al.: A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. N Engl J Med 1997, 337:663–669.PubMedCrossRefGoogle Scholar
  12. 12.
    Merli G, Spiro TE, Olsson CG, et al.: Subcutaneous enoxaparin once or twice daily compared with intravenous unfractionated heparin for treatment of venous thromboembolic disease. Ann Intern Med 2001, 134:191–202.PubMedGoogle Scholar
  13. 13.
    Cornuz J, Pearson SD, Creager MA, et al.: Importance of findings on the initial evaluation for cancer in patients with symptomatic idiopathic deep venous thrombosis. Ann Intern Med 1996, 125:785–793. This article strongly supports the notion that a careful and complete clinical evaluation, including history, physical examination, screening laboratory tests, and limited imaging studies can successfully identify cancers in patients presenting with idiopathic DVT. Further imaging, including CT scans, should probably be reserved for those with an abnormal initial clinical evaluation. We feel that these data should be appreciated by physicians who employ outpatient DVT management so that ambulatory patients are not sent home before a complete clinical evaluation is performed.PubMedGoogle Scholar
  14. 14.
    Prandoni P, Lensing AW, Büller HR, et al.: Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 1992, 327:1128–1133.PubMedCrossRefGoogle Scholar
  15. 15.
    Arcasoy SM, Kreit JW: Thrombolytic therapy of pulmonary embolism: a comprehensive review of current evidence. Chest 1999, 115:1695–1707. This is an outstanding review of the data available on the use of lytic agents in treating patients with PE. The advantages of thrombolysis, the efficacy and safety of lytic agents, as well as proper administration of lytic agents are extensively reviewed.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldhaber SZ: Thrombolysis in pulmonary embolism: a debatable indication. Thromb Haemost 2001, 86:444–451.PubMedGoogle Scholar
  17. 17.
    Jerjes-Sanchez C, Ramierez-Rivera A, de Lourdes Garcia M, et al.: Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis 1995, 2:227–229.PubMedGoogle Scholar
  18. 18.
    Raschke RA, Reilly BM, Guidry JR, et al.: The weightbased heparin dosing nomogram compared with a standard care nomogram: a randomized, controlled trial. Ann Intern Med 1993, 119:874–881.PubMedGoogle Scholar
  19. 19.
    Schwartz T, Schmidt B, Beyer J, et al.: Eligibility for home treatment of deep vein thrombosis: a prospective study in 202 consecutive patients. J Vasc Surg 2001, 34:1065–1070. This study looked at 202 consecutive patients diagnosed with DVT; 117 patients were outpatients and 85 patients were hospitalized prior to the diagnosis. Of the 117 outpatients, 81% (95 of 117) were eligible for outpatient therapy using LMWH to treat their DVT. Only three of 22 patients requiring hospitalization were admitted for DVT or medical comorbidity. The remaining 19 were admitted because of the inability to perform LMWH outpatient therapy.CrossRefGoogle Scholar
  20. 20.
    Wells PS, Kovacs MJ, Bormanis J, et al.: Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecularweight heparin. Arch Intern Med 1998, 158:1809–1812.PubMedCrossRefGoogle Scholar
  21. 21.
    Hirsh J, Dalen JE, Anderson DR, et al.: Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001, 119:8S-21S.PubMedCrossRefGoogle Scholar
  22. 22.
    Deitcher SR: Interpretation of the International Normalized Ratio in patients with liver disease. Lancet 2002, 359:47–48.PubMedCrossRefGoogle Scholar
  23. 23.
    Moll S, Ortel TL: Monitoring warfarin therapy in patients with lupus anticoagulants. Ann Intern Med 1997, 127:177–185.PubMedGoogle Scholar
  24. 24.
    Tebbe U, Graf A, Kamke W, et al.: Hemodynamic effects of double bolus reteplase versus alteplase infusion in massive pulmonary embolism. Am Heart J 1999, 138:39–44.PubMedCrossRefGoogle Scholar
  25. 25.
    Streift MB: Vena cava filters: a comprehensive review. Blood 2000, 95:3669–3677. The author provides a comprehensive review of the data available regarding the available IVC filters. In addition, some of the controversies regarding the management of patients with IVC filters, such as the ongoing need for anticoagulation following filter placement, the clinical indications for IVC filter placement, and the use of SVC filters are reviewed.Google Scholar
  26. 26.
    Mewissen MW, Seabrook GR, Meissner MH, et al.: Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999, 211:39–49.PubMedGoogle Scholar
  27. 27.
    Patel NH, Stookey KR, Ketcham DB, et al.: Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000, 11:1297–1302.PubMedCrossRefGoogle Scholar
  28. 28.
    O’Sullivan GJ, Semba CP, Sittner CA, et al.: Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol 2000, 11:823–836.PubMedCrossRefGoogle Scholar
  29. 29.
    Aburahma A, Perkins SE, Wulu JT, et al.: Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting. Ann Surg 2001, 233:752–760.PubMedCrossRefGoogle Scholar
  30. 30.
    Schweizer J, Kirch W, Koch R, et al.: Short- and long-term results after thrombolytic treatment of deep venous thrombosis. J Am Coll Cardiol 2000, 36:1336–1343. This study randomized 250 patients into five groups: a control group and four treatment groups (locoregional rtPA, 20 mg/d; locoregional urokinase, 100,000 IU/d; systemic streptokinase, three million IU/d; or systemic urokinase, five million IU/d). All patients received anticoagulation and compression therapy for 1 year following treatment. Systemic thrombolysis was more effective than locoregional thrombolytic infusion or anticoagulation in reducing the number of closed segments on venogram; however, there was a significant increase in bleeding events with the use of lytic agents.PubMedCrossRefGoogle Scholar
  31. 31.
    Comerota AJ, Throm RC, Mathias SD, et al.: Catheterdirected thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg 2000, 32:130–137. A retrospectively administered questionnaire study designed to assess the health-related quality of life in patients with a DVT treated with either catheter-directed thrombolysis using urokinase or standard anticoagulation. The thrombolysis group was statistically younger than the anticoagulation group (53 ± 17 years vs 61 ± 6 years, P = 0.039). However, the patients treated with thrombolysis reported better overall physical functioning, less stigmata of DVT, less health distress, and fewer postthrombotic syndrome symptoms compared with the patients treated with anticoagulation alone.PubMedCrossRefGoogle Scholar
  32. 32.
    Doerge H, Schoendube FA, Voss M, et al.: Surgical therapy of fulminant pulmonary embolism: early and late results. Thoracic Cardiovasc Surg 1999, 47:9–13. A retrospective study comparing the results of pulmonary embolectomy prior to the introduction of thrombolytics (group 1, 31 patients) and following the introduction of thrombolytics (group 2, 10 patients). Perioperative mortality was 29% and there was no difference between the groups. Most surviving patients had New York Heart Association class I or II functionality following the procedure.CrossRefGoogle Scholar
  33. 33.
    Brandjes DPM, Büller HR, Heijboer H, et al.: Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997, 349:759–762.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Steven R. Deitcher
    • 1
  • Teresa L. Carman
    • 1
  1. 1.Section of Vascular Medicine, Department of Cardiovascular MedicineThe Cleveland Clinic FoundationClevelandUSA

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