Thrombophilia secondary prevention: Difference between revisions
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**one spontaneous thrombosis at an unusual site (e.g. mesenteric or cerebral vein); | **one spontaneous thrombosis at an unusual site (e.g. mesenteric or cerebral vein); | ||
**one spontaneous thrombosis in the presence of more than a single genetic defect predisposing to a thromboembolic event. | **one spontaneous thrombosis in the presence of more than a single genetic defect predisposing to a thromboembolic event. | ||
*'''Long-term therapy to prevent recurrence:''' | |||
**After initial heparinization, standard therapy for patients with deep venous thrombosis (DVT) or pulmonary embolism (PE) typically includes anticoagulation with warfarin for 3– 12 months at a target INR between 2 and 3, this results in more than a 90% reduction in recurrence risk. | |||
**the lowest recurrence risks after discontinuation of anticoagulant therapy have been found after 6–12 months of initial therapy. Recurrences are less common when the initial event is associated with a transient risk factor (e.g. surgery, trauma, etc.). | |||
==References== | ==References== | ||
Revision as of 19:57, 20 February 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asiri Ediriwickrema, M.D., M.H.S. [2]
Overview
Secondary prevention strategies following acute thrombosis in patients with thrombophilia include anticoagulation.
Secondary Prevention
Thromboprophylaxis with anticoagulation may be recommended for secondary prevention of acute thrombosis in high risk acquired and inherited thrombophilias:[1][2][3][4][5][6][7]
- Antiphospholipid syndrome
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Eculizumab is a monocolonal antibody used for treatment of PNH
- Recurrent thrombosis
- Unprovoked thrombus
- History of life threatening thrombus or thrombosis in atypical locations
- Multiple inherited thrombophilias
- Malignancy with history of thrombosis
- Concerning family history
- Male sex
- Recommendations: At present, indefinite anticoagulation at a target INR of 2–3 is recommended only in the following high-risk patients:
- two or more spontaneous thromboses;
- one spontaneous thrombosis in the case of antithrombin deficiency or the antiphospholipid antibody syndrome;
- one spontaneous life-threatening thrombosis (e.g. near-fatal PE; cerebral, mesenteric or portal vein thrombosis);
- one spontaneous thrombosis at an unusual site (e.g. mesenteric or cerebral vein);
- one spontaneous thrombosis in the presence of more than a single genetic defect predisposing to a thromboembolic event.
- Long-term therapy to prevent recurrence:
- After initial heparinization, standard therapy for patients with deep venous thrombosis (DVT) or pulmonary embolism (PE) typically includes anticoagulation with warfarin for 3– 12 months at a target INR between 2 and 3, this results in more than a 90% reduction in recurrence risk.
- the lowest recurrence risks after discontinuation of anticoagulant therapy have been found after 6–12 months of initial therapy. Recurrences are less common when the initial event is associated with a transient risk factor (e.g. surgery, trauma, etc.).
References
- ↑ Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R; et al. (2016). "Guidance for the treatment of deep vein thrombosis and pulmonary embolism". J Thromb Thrombolysis. 41 (1): 32–67. doi:10.1007/s11239-015-1317-0. PMC 4715858. PMID 26780738.
- ↑ DeLoughery TG. Hemostasis and Thrombosis: Springer International Publishing; 2014.
- ↑ Cohoon KP, Heit JA (2014). "Inherited and secondary thrombophilia". Circulation. 129 (2): 254–7. doi:10.1161/CIRCULATIONAHA.113.001943. PMC 3979345. PMID 24421360.
- ↑ Seligsohn U, Lubetsky A (2001). "Genetic susceptibility to venous thrombosis". N Engl J Med. 344 (16): 1222–31. doi:10.1056/NEJM200104193441607. PMID 11309638.
- ↑ Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S; et al. (2012). "Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e278S–325S. doi:10.1378/chest.11-2404. PMC 3278063. PMID 22315265.
- ↑ Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A; et al. (2002). "Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer". N Engl J Med. 346 (13): 975–80. doi:10.1056/NEJMoa012385. PMID 11919306.
- ↑ Agnelli G (2004). "Prevention of venous thromboembolism in surgical patients". Circulation. 110 (24 Suppl 1): IV4–12. doi:10.1161/01.CIR.0000150639.98514.6c. PMID 15598646.