Tag Archive for: VTE

LMWH in Cancer-Related VTE (CLOT Study)

20 Sep
September 20, 2018

Background: Venous thromboembolism (VTE) occurs frequently in patient with cancer. Treatment in this group entails a number of challenges including a higher rate of thrombosis recurrence and a higher risk of bleeding. Standard therapy in 2018 for both symptomatic and asymptomatic VTE is with low-molecular-weight heparin (LMWH) based on this study. Prior to 2003, patients were treated with warfarin after bridging with either unfractionated or LMWH. This approach requires frequent monitoring due to unpredictable anticoagulation levels associated with drug interactions, malnutrition and vomiting. Due to these issues, treatment with LMWH alone may be both more efficacious as well as preferred by patients. Read more →

Edoxaban in Cancer-Associated VTE

30 Aug
August 30, 2018

Background: Venous thromboembolism (VTE) occurs frequently in patient with cancer. Treatment in this group entails a number of challenges including a higher rate of thrombosis recurrence and a higher risk of bleeding. Standard therapy at this time for both symptomatic and asymptomatic VTE is with low-molecular-weight heparin (LMWH) based on results from the CLOT trial (Lee 2003). In non-cancer patients, new oral anticoagulants (NOACs) like  rivaroxaban have been shown to be effective in treatment without increasing bleeding events. The NOACs also add ease of use for the patient. Though these agents are frequently used in the treatment of cancer-associated VTE, there is a dearth of evidence supporting this practice. Read more →

ACEP Clinical Policy on Acute VTE 2018

21 May
May 21, 2018

The evaluation and management of venous thromboembolism (VTE) in the Emergency Department (ED) is fraught with questions: who should I evaluate, who should get a d-dimer, what should the d-dimer threshold be etc. Answers, unfortunately, are far less common. Due to the enormous volume of literature produced on the topic, it can be difficult for individual clinicians to incorporate all of the information into a comprehensive approach. The ACEP policy subcommittee has taken this job on for the rest of us. This clinical policy addresses five critical questions but does so over 51 pages. We’ve boiled down the major points here. Read more →

Should I Stay or Should I Go: Outpatient Treatment of Venous Thromboembolism

05 Dec
December 5, 2016

venous-thromboembolismBackground: The care of venous thromboembolism (VTE) is currently undergoing a paradigm shift in the US with an increasingly large percentage of patients being discharged home from the Emergency Department (ED).  It wasn’t too long ago that all patients diagnosed with deep vein thrombosis (DVT) and pulmonary embolism (PE) would be admitted for anticoagulation.  Some of the reasons for this were lack of literature to support outpatient therapy in the US, inability to arrange outpatient follow up, and, of course, medicolegal concerns.  Dr. Jeff Kline, one of the thought leaders in VTE, advocates for the outpatient treatment of “low-risk” patients using a modified Hestia criteria supplemented with additional criteria (POMPE-C) for patients with active cancer.  This publication is the initial results of his rivaroxaban-based treatment protocol. Read more →

September 2015 REBELCast

07 Sep
September 7, 2015

September 2015 REBELCastWelcome to the September 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of topics in the world of Venous Thromboembolism (VTE). Seems like we are hearing more and more about VTE in terms of workup, management, etc. Lets face it, diagnosing someone with a pulmonary embolism (PE) is no longer as simple as checking a d-dimer or just doing a CT Pulmonary Angiogram.  There is so much more to it and to frustrate physicians even more there is so much research coming out on this topic alone, even I am having a hard time keeping up.  Swami, Matt, and I thought it might be good to tackle a couple of articles from he world of VTE that have implications for clinical practice and patient care. So with that introduction today we are going to specifically tackle:

  • Topic #1: Home Treatment of Low Risk Venous Thromboembolism with Rivaroxaban
  • Topic #2: RV Dilation on Bedside Echo Performed by ED Physicians

Read more →

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