Thromboembolic events

GPIIb/IIIa Integrin Receptor Antagonists In the Rapid Diagnosis of Thromboembolic Events... 

The role of the platelet integrin GPIIb/IIIa receptor and its potential utility as a radio-diagnostic agent in the rapid detection of thromboembolic events has been demonstrated [6]. This approach may be useful for the noninvasive diagnosis of various thromboembolic disorders. 

Celecoxib, which has a low selectivity for COX-2 compared to COX-1, is still available, although its more selective successor, valdecoxib has been withdrawn. Etoricoxib, the successor to rofecoxib, is marketed in Europe but not in the USA. In a large multinational clinical trial, etoricoxib caused no more thromboembolic events than diclofenac, but after 18 months the incidence of gastrointestinal ulcers and bleeding was the same for both drugs [4]. 

Thromboembolic events (myocardial infarction and stroke, see below)... 

Patients with HF are at an increased risk of thromboembolic events secondary to a combination of hypercoagulability, relative stasis of blood, and endothelial dysfunction. However, the role of antiplatelets and anticoagulants remains debatable due to a lack of prospective clinical trials. 

Given that VTE is often clinically silent and potentially fatal, prevention strategies have the greatest potential to improve patient outcomes.2 To rely on the early diagnosis and treatment of VTE is unacceptable because many patients will die before treatment can be initiated. Furthermore, even clinically silent disease is associated with long-term morbidity from the postthrombotic syndrome and predisposes the patient to future thromboembolic events. Despite an immense body of literature that overwhelmingly supports the widespread use of... 

Low-molecular-weight heparins and heparinoids are not recommended in the treatment of acute ischemic stroke.11 A meta-analysis was performed using data from 10 randomized controlled trials.19 A non-significant decrease in combined death and disability and a non-significant increase in case fatality and hemorrhage were seen. A reduction in venous thromboembolic events was observed in acute stroke patients however, there was also an increase in extracranial bleeding. 

The WHI demonstrated an increased risk in venous thromboembolic disease in the HRT group (0.34%) compared with placebo (0.16%) (HR 2.11,95% Cl 1.58-2.82). This translates into an NNTH of approximately 555 and 18 more cases of venous thromboembolic events for every 10,000 women treated per year with HRT.3 The risk for deep vein thrombosis also was increased in the ERT arm of the WHI, but pulmonary embolism was not increased significantly.21... 

Observational and prospective data have consistently demonstrated an increased risk in thromboembolic events with the use of HRT.2,3,19,20 Women taking HRT have approximately doubled the risk of those not taking HRT. Therefore, these risks need to be weighed carefully when considering the use of HRT for the treatment of vasomotor symptoms. 

Estramustine, an oral drug, also inhibits microtubule assembly and has weak estrogenic activity at the estradiol hormone receptors of the cell. Approximately 75% of a dose of estramustine is absorbed.15 The terminal half-life ranges between 20 to 24 hours, with nonrenal excretion as the major route of elimination. This drug is used primarily for the treatment of prostate cancer, but its use is limited by the side effects, which include nausea and vomiting, diarrhea, thromboembolic events, and gynecomastia. 

Bevacizumab 10 mg/kg IV on days 1 and 15, cycled every 28 days (paclitaxel 90 mg/m2 IV on days 1, 8 and 15) Hypertension, gastrointestinal perforation, impaired wound healing, bleeding, thromboembolic events, proteinuria... 

J Heparin-induced thrombocytopenia (HIT) is a serious immune-mediated problem that requires immediate intervention. For patients receiving therapeutic UFH doses, a baseline platelet count should be obtained before therapy is initiated and then every-other-day for 14 days or until therapy is stopped, whichever occurs first. HIT should be suspected if a patient develops a thromboembolic event (e.g., DVT, PE, stroke, myocardial infarction, limb artery occlusion) during or soon after receiving UFH. The platelet... 

CHCs are contraindicated in women with a history of thromboembolic events and in those at risk due to prolonged immobilization with major surgery unless they are taking anticoagulants. 

Emergency contraception (EC) has not been associated with an increased risk of thromboembolic events. 

The package insert provides preliminary data indicating a higher incidence of thromboembolic events with the patch. The benefits of increased compliance must be weighed against the risk of increased estrogen exposure and possibly more thromboembolic events. 

The major adverse effect is irregular menstrual bleeding. Other side effects are headache, vaginitis, weight gain, acne, and breast and abdominal pain. It does not appear to decrease BMD. It is contraindicated in women who are pregnant, have active liver disease, a history of thromboembolic events, or a history of breast cancer. 

Raloxifene treatment of osteoporosis was associated with a 76% risk reduction for estrogen-receptor positive breast cancer. An additional study showed that this reduced risk continues for up to 8 years. Among women at high risk for breast cancer, raloxifene was as effective as tamoxifen in reducing the risk of invasive breast cancer and had a lower risk of thromboembolic events. 

Women taking hormone therapy have a twofold increase in risk for thromboembolic events, with the highest risk occurring in the first year of use. The increased risk is dose dependent. 

Progestins are generally reserved for third-line therapy. They cause weight gain, fluid retention, and thromboembolic events. 

The combination of estramustine 280 mg by mouth three times daily on days 1 to 5 and docetaxel 60 mg/m2 on day 2 of a 21-day cycle also improves survival in hormone-refractory metastatic prostate cancer. Estramustine causes a decrease in testosterone and a corresponding increase in estrogen, which results in an increase in thromboembolic events, gynecomastia, and decreased libido. 

Decensi A, Maisonneuve P, Rotmenz N et al. (2005) Effect of Tamoxifen on venous thromboembolic events in a breast cancer prevention trial. Circulation 111 650-656... 

In September 2001, however, a news item in the British Medical Journal reported that further analyses confirmed the increase in rates of myocardial infarction and questioned whether this was an adverse reaction affecting the whole class of COX 2 drugs. The debate continued for the next 3 years with the main emphasis remaining on GI toxicity. A PEM study that included more than 15 000 patients made no mention of cardiovascular adverse events. However, a second paper compared rofecoxib and meloxicam with respect to thromboembolic events which showed that both, to a variable extent were associated with cardiovascular, cerebrovascular and peripheral venous pathology. A meta-analysis published recently in The Lancet suggests that Merck, the licence holder... 

Benzyl alcohol The multiple-dose vials of dalteparin, enoxaparin, and tinzaparin contain benzyl alcohol as a preservative. Benzyl alcohol has been associated with a fatal gasping syndrome in premature infants. Because benzyl alcohol may cross the placenta, do not use LMWHs preserved with benzyl alcohol in pregnant women. Thromboembolic events If thromboembolic events occur despite LMWH prophylaxis, discontinue and initiate appropriate therapy. 

To reduce the risk of death, recurrent Ml, and thromboembolic events such as stroke or systemic embolization after Ml. 

Women who are lactating or who are or may become pregnant (see Warnings) women with active or a history of venous thromboembolic events, including deep vein thrombosis, pulmonary embolism, and retinal vein thrombosis hypersensitivity to raloxifene or other constituents of the drug. 

Venous thromboembolic events. An analysis of raloxifene-treated women showed an increased risk of venous thromboembolic events defined as DVT and pulmonary embolism. Other venous thromboembolic events could also occur. A less serious... 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

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