Initial Treatment of Venous Thromboembolism

Adequate initial anticoagulant therapy of deep venous thrombosis (DVT) is required to prevent thrombus growth and pulmonary embolism (PE). Intravenous unfractionated heparin (UFH) is being replaced by low-molecular-weight heparin (LMWH) as the anticoagulant of choice for initial treatment of venous thromboembolism (VTE). Both agents are relatively safe and effective when used to treat VTE, with LMWH suitable for outpatient therapy because of improved bioavailability and more predictable anticoagulant response. Serious potential complications of heparin therapy, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, seem less common with LMWH. The potential for fetal harm and changes in maternal physiology complicate the treatment of VTE during pregnancy. Although systemic thrombolysis is used in patients with massive PE and in some patients with proximal DVT, controversy persists with respect to appropriate patient selection for this intervention.

[1]  H. Breddin.  Platelet count monitoring and laboratory testing for heparin-induced thrombocytopenia. , 2009, Archives of pathology & laboratory medicine.

[2]  D. Greenwood,et al.  Ascorbic Acid Prevents Contrast-Mediated Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention , 2004, Circulation.

[3]  O. Berenfeld,et al.  From Mouse to Whale: A Universal Scaling Relation for the PR Interval of the Electrocardiogram of Mammals , 2004, Circulation.

[4]  R. Califf,et al.  Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young , 2004, Circulation.

[5]  S. Solomon,et al.  Effect of Candesartan on Cause-Specific Mortality in Heart Failure Patients: The Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) Program , 2004, Circulation.

[6]  Alain Cribier,et al.  Acute Improvement in Global and Regional Left Ventricular Systolic Function After Percutaneous Heart Valve Implantation in Patients With Symptomatic Aortic Stenosis , 2004, Circulation.

[7]  M. Monreal,et al.  The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients. , 2003, Journal of vascular surgery.

[8]  M Gent,et al.  Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. , 2003, The New England journal of medicine.

[9]  H. Büller,et al.  Short‐ and long‐acting synthetic pentasaccharides , 2003, Journal of internal medicine.

[10]  Jeffrey I. Weitz,et al.  Emerging Anticoagulant Drugs , 2003, Arteriosclerosis, thrombosis, and vascular biology.

[11]  W. Haire.  Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. , 2003, Current hematology reports.

[12]  Prashanthan Sanders,et al.  Mapping and Ablation of Ventricular Fibrillation Associated With Long-QT and Brugada Syndromes , 2003, Circulation.

[13]  M. Prins,et al.  Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. , 2003, The New England journal of medicine.

[14]  Jeffrey S. Ginsberg,et al.  Management of venous thromboembolism during pregnancy , 2003, Journal of thrombosis and haemostasis : JTH.

[15]  D. Anderson,et al.  Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism , 2003, Annals of Internal Medicine.

[16]  T. Warkentin,et al.  Heparin‐induced thrombocytopenia: pathogenesis and management , 2003, British journal of haematology.

[17]  R. White,et al.  Low‐Molecular‐Weight Heparins: Are they all the Same? , 2003, British journal of haematology.

[18]  J. Hirsh,et al.  Is impaired renal function a contraindication to the use of low-molecular-weight heparin? , 2002, Archives of internal medicine.

[19]  J. Dalen.  The uncertain role of thrombolytic therapy in the treatment of pulmonary embolism. , 2002, Archives of internal medicine.

[20]  olfgang,et al.  HEPARIN PLUS ALTEPLASE COMPARED WITH HEPARIN ALONE IN PATIENTS WITH SUBMASSIVE PULMONARY EMBOLISM , 2002 .

[21]  E. Lindhoff‐Last,et al.  Incidence and clinical relevance of heparin‐induced antibodies in patients with deep vein thrombosis treated with unfractionated or low‐molecular‐weight heparin , 2002 .

[22]  A. Forster,et al.  The rationale and evidence for the treatment of lower-extremity deep venous thrombosis with thrombolytic agents , 2002, Current opinion in hematology.

[23]  H. Partsch.  Bed rest versus ambulation in the initial treatment of patients with proximal deep vein thrombosis , 2002, Current opinion in pulmonary medicine.

[24]  J. Barrett,et al.  Dosing in Heavy-weight/Obese Patients with the LMWH, Tinzaparin: A Pharmacodynamic Study , 2002, Thrombosis and Haemostasis.

[25]  V. Hiilesmaa,et al.  Postpartum Bone Mineral Density in Women Treated for Thromboprophylaxis with Unfractionated Heparin or LMW Heparin , 2002, Thrombosis and Haemostasis.

[26]  J. Julian,et al.  Low Molecular Weight Heparin Administered once versus twice Daily in Patients with Venous Thromboembolism , 2001, Thrombosis and Haemostasis.

[27]  D. Anderson,et al.  Effect of Patient Weight on the Anticoagulant Response to Adjusted Therapeutic Dosage of Low-Molecular- Weight Heparin for the Treatment ofVenous Thromboembolism , 2001, Pathophysiology of Haemostasis and Thrombosis.

[28]  V. Kakkar,et al.  Effects of a low-molecular-weight heparin on thrombus regression and recurrent thromboembolism in patients with deep-vein thrombosis. , 2001, The New England journal of medicine.

[29]  J. Hirsh,et al.  Use of a fixed activated partial thromboplastin time ratio to establish a therapeutic range for unfractionated heparin. , 2001, Archives of internal medicine.

[30]  R. Yusen,et al.  Subcutaneous Enoxaparin Once or Twice Daily Compared with Intravenous Unfractionated Heparin for Treatment of Venous Thromboembolic Disease , 2001, Annals of Internal Medicine.

[31]  S. Kitchen.  Problems in laboratory monitoring of heparin dosage. , 2000, British journal of haematology.

[32]  M. Prins,et al.  For the initial treatment of venous thromboembolism: are all low-molecular-weight heparin compounds the same? , 2000, Thrombosis research.

[33]  G. Raskob,et al.  Low-Molecular-Weight Heparin vs Heparin in the Treatment of Patients With Pulmonary Embolism , 2000 .

[34]  J. Douketis,et al.  A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency. , 2000, Archives of internal medicine.

[35]  G. Simonneau,et al.  High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. , 1999, Chest.

[36]  M. Prins,et al.  Recurrent venous thrombosis and heparin therapy: an evaluation of the importance of early activated partial thromboplastin times. , 1999, Archives of internal medicine.

[37]  J. Hirsh,et al.  A randomized trial comparing 5-mg and 10-mg warfarin loading doses. , 1999, Archives of internal medicine.

[38]  J. Hirsh,et al.  Assessment of outpatient treatment of deep-vein thrombosis with low-molecular-weight heparin. , 1998, Archives of internal medicine.

[39]  P. Wells,et al.  Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heparin: a comparison of patient self-injection with homecare injection. , 1998, Archives of internal medicine.

[40]  H. Ostermann.  Low molecular weight heparins , 1998, Der Internist.

[41]  J. Alpert,et al.  Thrombolytic therapy for pulmonary embolism: is it effective? Is it safe? When is it indicated? , 1997, Archives of internal medicine.

[42]  G. Raskob,et al.  Relation between the time to achieve the lower limit of the APTT therapeutic range and recurrent venous thromboembolism during heparin treatment for deep vein thrombosis. , 1997, Archives of internal medicine.

[43]  G. Simonneau,et al.  A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire. , 1997, The New England journal of medicine.

[44]  J. Nunnelee.  Low-molecular-weight heparin. , 1997, Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing.

[45]  J. Hirsh,et al.  The relation between the activated partial thromboplastin time response and recurrence in patients with venous thrombosis treated with continuous intravenous heparin. , 1996, Archives of internal medicine.

[46]  Paolo Prandoni,et al.  The Long-Term Clinical Course of Acute Deep Venous Thrombosis , 1996, Annals of Internal Medicine.

[47]  J. Hirsh,et al.  A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. , 1994, Archives of internal medicine.

[48]  Robert Raschke,et al.  The Weight-based Heparin Dosing Nomogram Compared with a Standard Care Nomogram , 1993, Annals of Internal Medicine.

[49]  J. Hirsh,et al.  Establishing a Therapeutic Range for Heparin Therapy , 1993, Annals of Internal Medicine.

[50]  Jeffrey S. Ginsberg,et al.  Use of antithrombotic agents during pregnancy. , 1992, Chest.

[51]  D. Hommes,et al.  Subcutaneous Heparin Compared with Continuous Intravenous Heparin Administration in the Initial Treatment of Deep Vein Thrombosis , 1992, Annals of Internal Medicine.

[52]  J. Hirsh,et al.  A standard heparin nomogram for the management of heparin therapy. , 1991, Archives of internal medicine.

[53]  G. Raskob,et al.  Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. , 1990, The New England journal of medicine.

[54]  M. Kersten,et al.  Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. , 1989, Chest.

[55]  D. Doyle,et al.  Adjusted subcutaneous heparin or continuous intravenous heparin in patients with acute deep vein thrombosis. A randomized trial. , 1987, Annals of internal medicine.

[56]  A. Wycherley,et al.  SAFETY AND EFFICACY OF WARFARIN STARTED EARLY AFTER SUBMASSIVE VENOUS THROMBOSIS OR PULMONARY EMBOLISM , 1986, The Lancet.

[57]  R. Blumhardt.  Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. , 1986, Investigative radiology.

[58]  G. Raskob,et al.  Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis. , 1986, The New England journal of medicine.

[59]  U. Albrechtsson,et al.  NEED FOR LONG-TERM ANTICOAGULANT TREATMENT IN SYMPTOMATIC CALF-VEIN THROMBOSIS , 1985, The Lancet.

[60]  J. Fareed,et al.  STRUCTURAL STUDIES ON A BIOLOGICALLY ACTIVE HEXASACCHARIDE OBTAINED FROM HEPARIN , 1981, Annals of the New York Academy of Sciences.

[61]  R. Rosenberg,et al.  Correlation between structure and function of heparin. , 1979, Proceedings of the National Academy of Sciences of the United States of America.

[62]  C. Dollery,et al.  Heparin Kinetics in Venous Thrombosis and Pulmonary Embolism , 1976, Circulation.

[63]  D. W. Barritt,et al.  Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. , 1960, Lancet.

[64]  J. McLean.  THE THROMBOPLASTIC ACTION OF CEPHALIN , 1916 .

[65]  G. Moneta.  Deletion of p66shc Gene Protects Against Age-Related Endothelial Dysfunction , 2006 .

[66]  C. Jerjes-Sánchez,et al.  Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial , 2005, Journal of Thrombosis and Thrombolysis.

[67]  M. Greaves,et al.  Limitations of the Laboratory Monitoring of Heparin Therapy , 2002, Thrombosis and Haemostasis.

[68]  E. Ohman,et al.  Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. , 2001, Chest.

[69]  F. Fabris,et al.  Heparin-induced thrombocytopenia. , 2000, Haematologica.

[70]  M. Gould,et al.  Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. , 1999, Annals of internal medicine.

[71]  R. Hull,et al.  Antithrombotic therapy for venous thromboembolic disease. , 1995, Chest.

[72]  J. Hirsh.  Drug therapy : heparin , 1991 .