Thrombophilia secondary prevention
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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
- 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.
| Table 1: Enlist the indications for the secondary prevention[1][2][3][4][5][6][7] |
| Indications for secondary thromboprophylaxis |
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- 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.