Outpatient management of patients with venous thromboembolic disease An article from the e-journal of the ESC Council for Cardiology Practice.
Upgrade to remove ads. What are the categories of Thromboembolic Disorders. Thromboembolic Disorders Cardioembolic disease. Atrial fibrillation, heart failure. Varicose Veins Traumatic thrombophlebitis Superficial vein thrombophlebitis is generally managed with supportive care unless the clot is very large or it is more proximal. Most common cause of superficial vein thrombosis, Cardio Thrombophlebitis.
Superficial vein thrombophlebitis is generally managed with supportive care unless the clot is very large or it is more proximal. Clinical Presentation of DVT.
Signs and Symptoms Superficial veins may be dilated and a "palpable cord" may be felt in the affected leg Leg swelling, pain or warmth. Laboratory and Cardio Thrombophlebitis tests for varicose veins. D-dimer Erythrocyte sedimentation rate and white blood cell count may be elevated Duplex ultrasonography is the most commonly used test to diagnosis DVT.
SPecificity rules IN disease SeNsitivity rules OUT disease Specificity rules in disease- if it is negative then you can rule out that disease Specificity- if it is positive you can't say they have the disease because it has a low sensitivity in terms of D-dimer.
DVT of the lower extremity most common is divided into two categories: Distal vein thrombosis below the knee Proximal vein Cardio Thrombophlebitis above the knee. Distal vein thrombosis below the knee. Calf veins Less likely to embolize to lungs Will sometimes monitor size and progression of clot over two weeks instead of anticoagulation.
Once formed, a Cardio Thrombophlebitis thrombus may, Cardio Thrombophlebitis. Remain asymptomatic Spontaneously lyse Obstruct venous blood flow Embolize.
Proximal vein thrombosis above the knee. Popliteal, femoral or iliac veins More likely to embolize to lungs Requires antithrombotic therapy, Cardio Thrombophlebitis. Risk Factors for VTE?? Causes of venous stasis?? Immobility Obesity Varicose veins Vascular Injury. Causes of vascular injury?? Causes of DVT associated with Hypercoaugulable states?? Oral and transdermal contraceptives Hormone replacement therapy Testosterone Selective estrogen receptor modulators e.
Major risk factors for DVT. What is the biggest risk factor for DVT. Wells Criteria for PE. Clinical Presentation of PE Symptoms.
Cough Chest pain Shortness of breath Hemoptysis-coughing blood. Clinical Cardio Thrombophlebitis of PE Signs.
Clinical Presentation of Cardio Thrombophlebitis Laboratory and diagnostic tests, Cardio Thrombophlebitis. Serum D-dimer elevated Erythrocyte sedimentation rate and white blood cell count may be elevated.
Unprovoked VTE implies that. Imaging Studies Used in Diagnosis Venous ultrasonography, Cardio Thrombophlebitis.
Detect DVT by demonstrating loss of normal venous compressibility and venous flow, Cardio Thrombophlebitis. Primary diagnostic imaging test for PE gold standard. Primarily used for patients unable to tolerate IV contrast.
Provoked VTE is one that Propolis trophic Geschwür zu behandeln caused by a known transitorische ischämische Blutung. Surgery, recent hospitalization Estrogen therapy Pregnancy Curable malignancy. Genetic disorders Factor V leiden.
Not all patients with DVT need to be hospitalized Patients with all of the following can be considered for outpatient treatment: Consider thrombolytic or embolectomy. Warfarin Overlap warfarin for at least days and discontinue when Cardio Thrombophlebitis is therapeutic for at least 24 hours. How long do you treat DVT, Cardio Thrombophlebitis. Overlap rapid acting parenteral anticoagulant UFH, LMWH, fondaparinux, argatroban, bivalirudin with warfarin for at least days and discontinue heparin when INR is therapeutic for at least 24 hours Warfarin preferred to be started earlier vs.
Patient has active cancer es ist nützlich, mit Krampfadern zu trinken DVT what is the 1st and 2nd line treatment.
Surgical removal of the clot Usually reserved when thrombolysis is contraindicated or has failed, Cardio Thrombophlebitis. In patients with an unprovoked DVT or PE who are stopping anticoagulant therapy and do not have a contraindication to aspirin, we suggest aspirin over no aspirin to prevent recurrent VTE Grade 2B. Catheter-directed instillation directly onto the clot is increasingly being used Less bleeding compared to systemic administration.
Low Molecular Weight Heparins. Is UFH renally adjusted. VTE prophylaxis Hospitalized medical patients at high risk. VTE prophylaxis Hospitalized medical patients at high risk who are at increased risk of bleeding. Mechanical thromboprophylaxis with graduated compression stockings recommended over no mechanical devices.
VTE prophylaxis Hospitalized medical patients at low risk. Recommend against pharmacologic or mechanical prophylaxis. At what CrCl do you decrease the enoxaparin dose and what is the new dose.
VTE prophylaxis - Pharmacologic Higher doses for prophylaxis may be used in hip or knee replacements. VTE Prophylaxis - Mechanical. Inferior Vena Cava IVC filters are reserved for patients where other prophylactic strategies cannot be used: Contraindications to anticoagulation Failed anticoagulation therapy. Heparin Induced Thrombocytopenia Onset. Cardio Thrombophlebitis days after initial exposure Lungenembolie abstrakt 2015 heparin.
Heparin Induced Thrombocytopenia Etiology. Low specificity; High sensitivity. Gold standard, but long turn around time and expensive. Low Intermediate High How do you monitor Argatroban Bivalirudin.
How do you monitor Fondaparinux. Cardio Thrombophlebitis Induced Thrombocytopenia Allergy. Patients diagnosed with HIT should avoid heparin, including low molecular weight heparins, for life. Educate Cardio Thrombophlebitis, family, Cardio Thrombophlebitis, and caregivers Add heparin allergy to medical profile.
Transitioning from argatroban to warfarin. If argatroban has to be discontinued, taper continuous infusion Dosing of Enoxaparin Dosing. Antifactor Xa level monitoring should be considered. Is there a proven reversal method for enoxaparin, Cardio Thrombophlebitis.
In what populations does enoxaparin need monitoring.
/18 ICDCM Codes I80*: Phlebitis and thrombophlebitis
Low molecular weight heparin in outpatient departments or at home are great advancements in the management of deep vein thrombosis.
New oral anticoagulant agents will further simplify this change, Cardio Thrombophlebitis. Review here how treatment has evolved from hospital to outpatient or home care and the criteria for selecting patients. Deep venous thrombosis DVTCardio Thrombophlebitis, because of its Cardio Thrombophlebitis, which include the risk of pulmonary embolism and posthrombotic syndrome, is a serious disease.
Its incidence increases with age and accounts for between cases per adult subjects 1. There were various reasons for such management of venous thrombosis and pulmonary embolism, Cardio Thrombophlebitis. One was the prevailing opinion that patients with VTE need strict bed rest to prevent thrombus mobilisation from the thrombosed peripheral veins leading to pulmonary embolism. Further, the Cardio Thrombophlebitis treatment options of the acute disease with Cardio Thrombophlebitis heparin UFH were applicable only in hospital.
Since, evidence has shown that bed rest does not prevent complications, including PE, and new anticoagulant drugs, particularly low-molecular weight heparin LMWHpromote safe and effective treatment of DVT at home and in the out-patient department. Many years ago it was shown that the anticoagulant drugs heparin and vitamin K antagonist significantly reduce thromboembolic complications PE and mortality.
Simultaneously they received warfarin during the acute phase of the disease or longer - for at least three months. Such a treatment involves frequent regulatory check-ups to determine the optimal dosage of the drug for the individual patient. Therefore, treatment of this disease was possible only in hospital. However, with the development of new parenteral anticoagulant drugs LMWHs two decades ago, and the recognition that early mobilisation does not increase the frequency of PE 3 the management of patients with VTE 4 changed significantly.
Furthermore, low molecular weight heparin in comparison to UFH has many advantages; better bioavailability, a more standard and predictable anticoagulant effect and consequently regular check-ups of anticoagulant effects are not needed.
It was also shown that patients with DVT accompanied by PE without Cardio Thrombophlebitis haemodynamic consequences can be safely treated at home 67, Cardio Thrombophlebitis.
Further, in the last decade new oral anticoagulant agents direct factor Xa and thrombin Cardio Thrombophlebitis have demonstrated advantages over traditional anticoagulants, Cardio Thrombophlebitis, including administration at fixed doses, fewer food and drug interactions, and no requirement for routine coagulation monitoring.
Similarly, rivaroxaban, a direct oral factor Xa inhibitor, is effective in treatment of DVT and it has non-inferior efficacy in respect to enoxaparin followed by vitamin K antagonist - with the same safety profile 9. In patients with acute DVT, apixaban, a direct oral Cardio Thrombophlebitis Xa inhibitor, showed efficacy and safety similar to low-molecular-weight heparin followed by vitamin K antagonist, and was associated with significantly less bleeding There are different therapeutic protocols for management of DVT with new oral anticoagulants: This shift in the type of treatment of DVT and the shift from hospital to outpatient department was enabled after the introduction of LMWH and after numerous controlled studies confirmed that outpatient treatment with LMWH is as effective and safe as traditional Cardio Thrombophlebitis treatment with UFH.
In both studies, the recurrent rate of VTE was low and comparable between the groups. One group was treated with LMWH at home from the start, Cardio Thrombophlebitis, whereas patients from the second group were first treated with LMWH in hospital for Cardio Thrombophlebitis week and in the outpatient department after that. There were no significant differences in the efficacy of treatment and complications including major bleeding It seems that outpatient treatment of DVT is simpler.
Cardio Thrombophlebitis, outpatient treatment of DVT is based on the ability to coordinate multiple services, while hospitals have an integrated model of healthcare so that it is easy to manage patients with DVT in hospitals.
Meanwhile, outpatient DVT management provides more patient satisfaction than inpatient treatment, and is associated with higher levels of physical activity, better social functioning and a more rapid return to active every-day life Home treatment of DVT is also less costly than in-hospital treatment 15 The new anticoagulant drugs will probably further simplify treatment of thromboembolic disorders in the outpatient setting, Cardio Thrombophlebitis.
Most patients with objectively confirmed DVT and patients with asymptomatic pulmonary embolism could be safely treated in an outpatient department or at home. Exclusion criteria for home treatment of DVT comprise: In the past, conventional management Cardio Thrombophlebitis an acute DVT consisted of initiating continuous infusion of intravenous unfractionated heparin in hospital, Cardio Thrombophlebitis, and patient bed rest.
Cardio Thrombophlebitis advent of low molecular weight heparin, which exhibits prolonged bioavailability and easy dosing, has enabled outpatient management of DVT. Outpatient management of DVT Cardio Thrombophlebitis several advantages; it enables a higher level of physical activity, better social functioning and is less costly than hospital treatment.
With only a few exceptions, most patients with DVT and low-risk symptomatic pulmonary embolism can be safely treated in the outpatient department. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med ; 2: A history of pulmonary embolism and deep venous thrombosis, Cardio Thrombophlebitis. Crit Care Clin Krampfadern an den Beinen Tabletten 1: Acute deep vein thrombosis: Thromb Haemost ;85 1: Immediate mobilisation in acute vein thrombosis reduces post-thrombotic syndrome, Cardio Thrombophlebitis.
Int Angiol ;23 3: Comparison of subcutaneous low-molecular-weight heparin with intravenous standard heparin in proximal deep-vein thrombosis. Outpatient treatment of patients with deep-vein thrombosis or pulmonary embolism.
Curr Opin Pulm Med ;7 5: A European view on the North American fifth consensus on antithrombotic therapy. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med ; Oral rivaroxaban for symptomatic venous thromboembolism. Oral apixaban for the treatment of acute Cardio Thrombophlebitis thromboembolism, Cardio Thrombophlebitis.
Cardio Thrombophlebitis Engl J Med ; Cardio Thrombophlebitis Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. Clinical outcome and cost Cardio Thrombophlebitis hospital vs home treatment of proximal deep vein thrombosis with a low-molecular-weight heparin: Arch Intern Med ; Assessment of outpatient treatment of deep-vein thrombosis with low-molecular-weight heparin, Cardio Thrombophlebitis.
Outpatient therapy with low molecular weight heparin for the treatment of venous thromboembolism: Am J Med ; 4: Outpatient treatment of venous thromboembolism with low-molecular-weight heparin: Am J Manag Care ;8 1 Suppl: To reduce the burden of cardiovascular disease.
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Show navigation Hide navigation. E-Journal of Cardiology Practice. Background Deep venous thrombosis Cardio Thrombophlebitisbecause of its sequelae, which include the risk of pulmonary embolism and posthrombotic syndrome, Cardio Thrombophlebitis, is a serious disease. Notes to editor Prof.
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A deep vein thrombosis (DVT) Deep vein thrombophlebitis in the leg can cause aching or cramping, especially when walking or flexing the foot. Back to Top.
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I Phlebitis and thrombophlebitis of other and unspecified deep vessels of lower extremities. I Phlebitis and thrombophlebitis of unspecified deep vessels of.