Thrombophilia secondary prevention: Difference between revisions
Jump to navigation
Jump to search
| Line 7: | Line 7: | ||
==Secondary Prevention== | ==Secondary Prevention== | ||
*'''Long-term therapy to prevent recurrence:''' | |||
**'''90% risk reduction:''' The standard therapy for patients with DVT or PE typically includes anticoagulation with warfarin for 3– 12 months at a target INR between 2-3 after initial heparinization course. | |||
**Recurrences are less common after 6–12 months of discontinuation of anticoagulant therapy and when the initial event is associated with a transient risk factor such as surgery, trauma, etc. | |||
Thromboprophylaxis with [[anticoagulation]] may be recommended for secondary prevention of acute thrombosis in high risk acquired and inherited thrombophilias:<ref name="pmid26780738">{{cite journal| author=Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R et al.| title=Guidance for the treatment of deep vein thrombosis and pulmonary embolism. | journal=J Thromb Thrombolysis | year= 2016 | volume= 41 | issue= 1 | pages= 32-67 | pmid=26780738 | doi=10.1007/s11239-015-1317-0 | pmc=4715858 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26780738 }} </ref><ref name=?>DeLoughery TG. Hemostasis and Thrombosis: Springer International Publishing; 2014.</ref><ref name="pmid24421360">{{cite journal| author=Cohoon KP, Heit JA| title=Inherited and secondary thrombophilia. | journal=Circulation | year= 2014 | volume= 129 | issue= 2 | pages= 254-7 | pmid=24421360 | doi=10.1161/CIRCULATIONAHA.113.001943 | pmc=3979345 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24421360 }} </ref><ref name="pmid11309638">{{cite journal| author=Seligsohn U, Lubetsky A| title=Genetic susceptibility to venous thrombosis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 16 | pages= 1222-31 | pmid=11309638 | doi=10.1056/NEJM200104193441607 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11309638 }} </ref><ref name="pmid22315265">{{cite journal| author=Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al.| title=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. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e278S-325S | pmid=22315265 | doi=10.1378/chest.11-2404 | pmc=3278063 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315265 }} </ref><ref name="pmid11919306">{{cite journal| author=Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A et al.| title=Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 13 | pages= 975-80 | pmid=11919306 | doi=10.1056/NEJMoa012385 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11919306 }} </ref><ref name="pmid15598646">{{cite journal| author=Agnelli G| title=Prevention of venous thromboembolism in surgical patients. | journal=Circulation | year= 2004 | volume= 110 | issue= 24 Suppl 1 | pages= IV4-12 | pmid=15598646 | doi=10.1161/01.CIR.0000150639.98514.6c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15598646 }} </ref> | Thromboprophylaxis with [[anticoagulation]] may be recommended for secondary prevention of acute thrombosis in high risk acquired and inherited thrombophilias:<ref name="pmid26780738">{{cite journal| author=Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R et al.| title=Guidance for the treatment of deep vein thrombosis and pulmonary embolism. | journal=J Thromb Thrombolysis | year= 2016 | volume= 41 | issue= 1 | pages= 32-67 | pmid=26780738 | doi=10.1007/s11239-015-1317-0 | pmc=4715858 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26780738 }} </ref><ref name=?>DeLoughery TG. Hemostasis and Thrombosis: Springer International Publishing; 2014.</ref><ref name="pmid24421360">{{cite journal| author=Cohoon KP, Heit JA| title=Inherited and secondary thrombophilia. | journal=Circulation | year= 2014 | volume= 129 | issue= 2 | pages= 254-7 | pmid=24421360 | doi=10.1161/CIRCULATIONAHA.113.001943 | pmc=3979345 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24421360 }} </ref><ref name="pmid11309638">{{cite journal| author=Seligsohn U, Lubetsky A| title=Genetic susceptibility to venous thrombosis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 16 | pages= 1222-31 | pmid=11309638 | doi=10.1056/NEJM200104193441607 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11309638 }} </ref><ref name="pmid22315265">{{cite journal| author=Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al.| title=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. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e278S-325S | pmid=22315265 | doi=10.1378/chest.11-2404 | pmc=3278063 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315265 }} </ref><ref name="pmid11919306">{{cite journal| author=Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A et al.| title=Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 13 | pages= 975-80 | pmid=11919306 | doi=10.1056/NEJMoa012385 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11919306 }} </ref><ref name="pmid15598646">{{cite journal| author=Agnelli G| title=Prevention of venous thromboembolism in surgical patients. | journal=Circulation | year= 2004 | volume= 110 | issue= 24 Suppl 1 | pages= IV4-12 | pmid=15598646 | doi=10.1161/01.CIR.0000150639.98514.6c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15598646 }} </ref> | ||
*[[Antiphospholipid syndrome]] | *[[Antiphospholipid syndrome]] | ||
| Line 25: | Line 30: | ||
**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. | ||
==References== | ==References== | ||
Revision as of 18:20, 10 March 2021
|
Thrombophilia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Thrombophilia secondary prevention On the Web |
|
American Roentgen Ray Society Images of Thrombophilia secondary prevention |
|
Risk calculators and risk factors for Thrombophilia secondary prevention |
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
- Long-term therapy to prevent recurrence:
- 90% risk reduction: The standard therapy for patients with DVT or PE typically includes anticoagulation with warfarin for 3– 12 months at a target INR between 2-3 after initial heparinization course.
- Recurrences are less common after 6–12 months of discontinuation of anticoagulant therapy and when the initial event is associated with a transient risk factor such as surgery, trauma, etc.
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.
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.