Arterial thromboembolism

Streptokinase + 35% +++/+ Infusion over 60 minutes 613 Pulmonary embolism, deep vein thrombosis, arterial thromboembol ism, clearance of an occluded arteriovenous catheter... 

The serious adverse effects associated with bevacizumab include GI perforation, hemorrhage, hypertension, complications in wound healing, nephritic syndrome, congestive heart failure and arterial thromboembolic events. Patients receiving bevacizumab commonly experience pain, asthenia, headache, abdominal pain, nausea, vomiting, anorexia, upper respiratory infection and exfoliative dermatitis. 

Thrombosis in the dural sinuses or cerebral veins is much less common than cerebral arterial thromboembolism. It causes a variety of clinical syndromes, which often do not resemble stroke (Bousser and Ross Russell 1997). While ischemic arterial stroke and cerebral venous thrombosis share some causes (Southwick et al. 1986), others are specific to cerebral venous thrombosis (Table 29.1). A particularly high index of suspicion is required in women on the oral contraceptive pill (Saadatnia and Tajmirriahi 2007) and in the puerperium. In the past, cerebral venous thrombosis was strongly associated with otitis media and mastoiditis, lateral sinus thrombosis or otitic hydrocephalus, but the most common causes are now pregnancy and the puerperium, which cause 5-20% of the cerebral venous thrombosis in the developed world, the oral contraceptive pill, malignancy, dehydration, inflammatory disorders and hereditary coagulation disorders. No cause is found in around 20% of cases. 

Based on current data, 80 to 160 mg of aspirin per day (1 -2 baby aspirin tablets) provides the maximal antithrombotic effect of the dmg. There is considerable in vitro and clinical evidence supporting the choice of a daily dose of 80 to 160 mg for the prevention of arterial thromboembolism in all high risk situations (4). 

Higher aspirin doses of 900 to 1,500 mg per day have not been shown to have increased efficacy in arterial thromboembolism prevention when compared with 300 mg per day or lower doses. In one metaanalysis of 19 antiplatelet trials in several thrombotic disorders, the issue of aspirin dosage was indirectly analyzed (44). It was found that trials employing 900 to 1,500 mg of daily aspirin versus placebo had similar outcomes to trials employing doses of 300 to 325 mg per day versus placebo. Patients treated with 900 to 1,500 mg experienced a 23% reduction in new vascular events, whereas those taking 320 mg showed a decrease of 24%. Thus a dose-response plateau appears to exist in aspirin s antithrombotic effect. Clinical and laboratory observations are complimentary in this reqrect since aspirin inhibition of in vitro platelet PG synthesis shows a similar dose-re nse plateau with maximal blockade at micromolar concentrations (2,25,28). 

Kronenberg F, Lhotta K, Konigsrainer A, Konig P. Renal artery thromboembolism and immunosuppressive therapy. Nephron 1996 72(1) 101. 

Patients with clinical evidence of pulmonary embolus or suspected embolism who are hemodynamically stable Arterial thromboembolism or patients who are currently receiving dialysis, actively bleeding, have had recent (within 2 weeks) major surgery/trauma, or have other severe uncompensated co-morbid conditions May vary depending on the patient s clinical condition... 

Although the adverse effects of OC therapy include an increased risk of stroke, acute myocardial infarction, and venous thromboembolic disease, the incidence of cardiovascular disease in this patient population (age, <35 years) is already low (66). In women older than 35 years, the natural incidence of cardiovascular disease increases, so these adverse effects become more important to consider. From a metabolic perspective, the primary adverse effect of the estrogen component is an increase in hepatic production of proteins, including those that enhance venous and arterial thromboembolism (70). In addition, the progestin component has an adverse effect... 

Combination oral contraceptives have been associated with venous and arterial thromboembolism, pulmonary embolism, myocardial infarction, and thrombotic stroke. 

Scappaticci FA et al. Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. Journal of the National Cancer Institute 2007 99 1232-1239. 

Observational studies In a prospective study of bevacizumab combined with chemotherapy for first-line treatment of metastatic colorectal cancer, bevacizumab-related adverse events were gastrointestinal perforation (1.9%), arterial thromboembolic events (2%), grade 3—4 bleeding (2.2%), and de novo hypertension requiring medication (22%) [81 =]. 

Bevacizumab plus first-line chemotherapy has been evaluated in the Bevacizumab Expanded Access Trial (BEAT) in patients with unresectable metastatic colorectal cancer [82 ]. The serious/grade 3-5 adverse events with bevacizumab included hypertension (5.3%), bleeding (3%), gastrointestinal perforation (2%), arterial thromboembolism (1%), proteinuria (1%), and wound-healing complications (1%). 

In a meta-analysis of randomized controlled trials, the incidences of all-grade and high-grade arterial thromboembolic events in patients who received bevacizumab were 3.3% and 2.0% respectively. Patients who received bevacizumab had a significantly increased risk of arterial thromboembolic events compared with controls (RR = 1.4 95% CI = 1.1, 1.9). The risk was similarly increased by bevacizumab at 2.5 and 5 mg/kg/week in addition, there were... 

Ranpura V, Hapani S, Chuang J, Wu S. Risk of cardiac ischemia and arterial thromboembolic events with the angiogenesis inhibitor bevacizumab in cancer patients a metaanalysis of randomized controlled trials. Acta Oncol 2010 49(3) 287-97. 

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