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Current Management of Pulmonary Thromboembolism

정맥혈전증의 최신 치료: 항응고치료를 중심으로

  • Kim, Yang-Ki (Department of Respiratory Medicine, Thrombosis Clinic, Soonchunhyang University Seoul Hospital)
  • 김양기 (순천향대학교 서울병원 호흡기내과, 혈전클리닉)
  • Published : 2013.05.01

Abstract

The incidence of venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing in Korea. In addition, awareness of VTE according to the incidence is improving, but how long VTE should be treated and how effective VTE patients should be managed with warfarin is not well defined. Recently, various new oral anticoagulants (NOACs) were introduced in clinical practice. The duration of anticoagulation, quality control of warfarin, and practical use of NOACs in VTE would be reviewed with evidences.

Keywords

References

  1. Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9:85-91. https://doi.org/10.1111/j.1538-7836.2010.04108.x
  2. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl):e419S-494S. https://doi.org/10.1378/chest.11-2301
  3. Agnelli G, Prandoni P, Santamaria MG, et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis: Warfarin Optimal Duration Italian Trial Investigators. N Engl J Med 2001;345:165-169. https://doi.org/10.1056/NEJM200107193450302
  4. Boutitie F, Pinede L, Schulman S, et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials. BMJ 2011;342:d3036. https://doi.org/10.1136/bmj.d3036
  5. Schulman S, Granqvist S, Holmstrom M, et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism: the Duration of Anticoagulation Trial Study Group. N Engl J Med 1997;336:393-398. https://doi.org/10.1056/NEJM199702063360601
  6. Garcia DA, Baglin TP, Weitz JI, Samama MM; American College of Chest Physicians. Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl): e24S-43S. https://doi.org/10.1378/chest.11-2291
  7. Schulman S. Advances in the management of venous thromboembolism. Best Pract Res Clin Haematol 2012;25: 361-377. https://doi.org/10.1016/j.beha.2012.06.003
  8. Goudable C, Saivin S, Houin G, et al. Pharmacokinetics of a low molecular weight heparin (Fraxiparine) in various stages of chronic renal failure. Nephron 1991;59:543-545. https://doi.org/10.1159/000186641
  9. Becker RC, Spencer FA, Gibson M, et al. Influence of patient characteristics and renal function on factor Xa inhibition pharmacokinetics and pharmacodynamics after enoxaparin administration in non-ST-segment elevation acute coronary syndromes. Am Heart J 2002;143:753-759. https://doi.org/10.1067/mhj.2002.120774
  10. Sanderink GJ, Guimart CG, Ozoux ML, Jariwala NU, Shukla UA, Boutouyrie BX. Pharmacokinetics and pharmacodynamics of the prophylactic dose of enoxaparin once daily over 4 days in patients with renal impairment. Thromb Res 2002;105:225-231. https://doi.org/10.1016/S0049-3848(02)00031-2
  11. Lim W, Dentali F, Eikelboom JW, Crowther MA. Meta-analysis: low-molecular-weight heparin and bleeding in patients with severe renal insufficiency. Ann Intern Med 2006;144: 673-684. https://doi.org/10.7326/0003-4819-144-9-200605020-00011
  12. Buller HR, Davidson BL, Decousus H, et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med 2003;349:1695-1702. https://doi.org/10.1056/NEJMoa035451
  13. Buller HR, Davidson BL, Decousus H, et al. Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med 2004;140:867-873. https://doi.org/10.7326/0003-4819-140-11-200406010-00007
  14. Rosendaal FR, Cannegieter SC, van der Meer FJ, Briët E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993;69:236-239.
  15. Veeger NJ, Piersma-Wichers M, Tijssen JG, Hillege HL, van der Meer J. Individual time within target range in patients treated with vitamin K antagonists: main determinant of quality of anticoagulation and predictor of clinical outcome: a retrospective study of 2300 consecutive patients with venous thromboembolism. Br J Haematol 2005;128:513-519. https://doi.org/10.1111/j.1365-2141.2004.05348.x
  16. Van Walraven C, Oake N, Coyle D, Taljaard M, Forster AJ. Changes in surrogate outcomes can be translated into clinical outcomes using a Monte Carlo model. J Clin Epidemiol 2009;62:1306-1315. https://doi.org/10.1016/j.jclinepi.2009.01.015
  17. Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e152S-184S. https://doi.org/10.1378/chest.11-2295
  18. Kim YK, Nieuwlaat R, Connolly SJ, et al. Effect of a simple two-step warfarin dosing algorithm on anticoagulant control as measured by time in therapeutic range: a pilot study. J Thromb Haemost 2010;8:101-106. https://doi.org/10.1111/j.1538-7836.2009.03652.x
  19. Nieuwlaat R, Hubers LM, Spyropoulos AC, et al. Randomised comparison of a simple warfarin dosing algorithm versus a computerised anticoagulation management system for control of warfarin maintenance therapy. Thromb Haemost 2012;108:1228-1235. https://doi.org/10.1160/TH12-06-0433
  20. Adam SS, McDuffie JR, Ortel TL, Williams JW Jr. Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review. Ann Intern Med 2012; 157:796-807. https://doi.org/10.7326/0003-4819-157-10-201211200-00532
  21. Weitz JI, Eikelboom JW, Samama MM; American College of Chest Physicians. New antithrombotic drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl): e120S-151S. https://doi.org/10.1378/chest.11-2294
  22. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009;361:2342-2352. https://doi.org/10.1056/NEJMoa0906598
  23. Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-2510. https://doi.org/10.1056/NEJMoa1007903
  24. Buller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012;366:1287-1297. https://doi.org/10.1056/NEJMoa1113572
  25. Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med 2013;368:699-708. https://doi.org/10.1056/NEJMoa1207541
  26. Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013;368:709-718. https://doi.org/10.1056/NEJMoa1113697
  27. Schulman S, Crowther MA. How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch. Blood 2012;119:3016-3023. https://doi.org/10.1182/blood-2011-10-378950
  28. Peacock WF, Gearhart MM, Mills RM. Emergency management of bleeding associated with old and new oral anticoagulants. Clin Cardiol 2012;35:730-737. https://doi.org/10.1002/clc.22037

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