Venous thromboembolism anticoagulants

Recommendations from the American College of Chest Physicians (ACCP) for duration of anticoagulant therapy after venous thromboembolism (VTE)... 

Gallus AS. Anticoagulants in the prevention of venous Thromboembolism. Bailliere s Clin Haematol 1990 3(3) 65l-84. 

The scope of the medical problems which require the use of anticoagulant drugs cannot be overstated. Arterial thrombosis is a major contributor to the number one (acute myocardial infarction), number three (stroke) and number four (renal) causes of death in the United States (1J. Venous thromboembolism is the most common non-surgical cause of death in patients hospitalized for major orthopedic procedures, the most frequent non-obstetrical cause of postpartum death, and a major cause of death in patients with chronic cardiac and pulmonary disease (1 ). Venous thrombosis is estimated to lead to the hospitalization of approximately... 

Low-dose unfractionated heparin or LMW heparin can be used to prevent venous thromboembolism in other high-risk patients, e.g. those confined to bed and immobilised with strokes, cardiac failure or malignant disease. Spontaneous bleeding has not been a problem with this form of anticoagulant treatment. 

Acute myocardial infarction. Anticoagulation with heparin is used to reduce the risk of venous thromboembolism, and the risk and size of emboli from mural thrombi following acute myocardial infarction. 

A 64-year-old obese man, scheduled for a hernia repair, had had previous episodes of venous thromboembolism, for which he was still taking an oral anticoagulant. Previous general anesthesia had been uneventful. General anesthesia was induced with sufentanil 15 xg and propofol 400 mg. He was given rocuronium 50 mg to facilitate endotracheal intubation, and shortly after... 

Indications Prevention of venous thromboembolic events. Category Anticoagulant Half-life 2.5 Days... 

ADMINISTRATION AND MONITORING FuU-dose heparin therapy usually is administered by continuous intravenous infusion. Treatment of venous thromboembolism is initiated with a bolus injection of 5000 units, followed by 1200-1600 units/h delivered by an infusion pump. Therapy routinely is monitored by the aPTT the target is an elevation to 1.8-2.5 times the normal value. The risk of recurrence of thromboembolism is greater in patients who do not achieve a therapeutic level of anticoagulation within the first 24 hours. Initially, the aPTT should be measured and the infusion rate adjusted every 6 hours dose adjustments may be aided by use of a nomogram. Once a steady dosage schedule has been established, daily monitoring is sufficient. 

Venous thromboembolism (VTE) is a complicating condition responsible for high morbidity and mortality in North America and Europe. This disease commonly is linked to advanced age but has both hereditary and acquired risk factors, such as surgery, any form of trauma, and childbirth, associated with it. It encompasses the conditions of deep vein thrombosis (DVT) and pulmonary embolism. In excess of 60,000 deaths annually are attributed to pulmonary embolism. Preventative therapy consists of the use of two different classes of antithrombotic agents, namely anticoagulants and antiplatelet drugs (1,2). 

Blanchard E, Ansell J. Extended anticoagulation therapy for the primary and secondary prevention of venous thromboembolism. Drugs 2005 65 303-311. 

Note that, because of the increased risk of developing venous thromboembolism with HRT, the use of HRT in women already on anticoagulant therapy requires careful consideration of the risks and benefits. Whether tibolone is associated with the same risk is unknown, therefore similar caution would seem prudent... 

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