Safe‐Dose Thrombolysis Plus Rivaroxaban for Moderate and Severe Pulmonary Embolism: Drip, Drug, and Discharge

Abstract BackgroundThrombolysis, though very effective, has not been embraced as routine therapy for symptomatic pulmonary embolism (PE) except in very severe cases. Rivaroxaban recently has been approved for the treatment of venous thromboembolism (VTE). There are no data on the combined use of thrombolysis and rivaroxaban in PE. Hypothesis“Safe dose” thrombolysis (SDT) plus new oral anticoagulants are expected to become an appealing, safe and effective approach in the treatment of moderate and severe PE in the near future, thereby drastically reducing hospitalization time. MethodsOver a 12‐month period, 98 consecutive patients with symptomatic PE were treated by a combination of SDT and rivaroxaban. The SDT was started in parallel with unfractionated heparin and given in 2 hours. Heparin was given for a total of 24 hours and rivaroxaban started at 15 or 20 mg daily 2 hours after termination of heparin infusion. ResultsThere was no bleeding due to SDT. Recurrent VTE occurred in 3 patients who had been switched to warfarin. No patient on rivaroxaban developed VTE. Two patients died of cancer at a mean follow‐up of 12 ± 2 months. The pulmonary artery systolic pressure dropped from 52.8 ± 3.9 mm Hg before to 32 ± 4.4 mm Hg within 36 hours of SDT (P
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: Clinical Investigation Source Type: research

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CONCLUSIONS: Apixaban is more cost-effective than enoxaparin for the prevention of postoperative VTE in patients with gynecologic cancer. This appears to be driven largely by DVT and CRNMB prevention. PMID: 32854972 [PubMed - as supplied by publisher]
Source: Gynecologic Oncology - Category: Cancer & Oncology Authors: Tags: Gynecol Oncol Source Type: research
Discussion Pediatric cancers in the US number about 12,000 per year. After injury, it is the second leading cause of death in children and adolescents. Cancer presentations vary widely, but often begin with non-specific symptoms that continue or progress depending on the location and tumor type. Patients can present with oncological emergencies especially if there are mechanical obstruction such as superior vena cava syndrome or cerebral herniation. More commonly are infections due to immunosuppression. Cancer treatment also causes its own myriad of problems that clinicians need to be aware of to diagnosis and treat, but a...
Source: - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Thromboprophylaxis with rivaroxaban is safe and effective in the prevention of venous thromboembolism in ambulatory patients with pancreatic cancer receiving systemic therapy, with a low number needed to treat. Given the favorable risk ‐benefit ratio and convenience of the oral route of administration, these findings should inform guideline recommendations for high‐risk patients. AbstractBackgroundPancreatic cancer patients are at risk for venous thromboembolism (VTE); the value of thromboprophylaxis has not been definitively established.MethodsThis trial randomized cancer patients initiating a new regimen and at high ...
Source: Cancer Medicine - Category: Cancer & Oncology Authors: Tags: ORIGINAL RESEARCH Source Type: research
CONCLUSIONS: In DOAC therapy for cancer-associated VTE, major bleeding prevention is important because it is an independent risk factor of death. PMID: 32624519 [PubMed - as supplied by publisher]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Authors: Spehlmann ME, Frey N, Müller OJ Abstract Deep vein thrombosis and pulmonary artery embolism are common and serious concomitant diseases in patients with cancer. The prophylaxis and therapy of such venous thromboembolic events (VTE) in oncology have so far been achieved with low-molecular-weight heparins. An increasing number of studies show evidence of the use of direct oral anticoagulants. However, since none of the possible options were shown to have a clear advantage in all patients, the individual decision to use a drug should be made depending on its effectiveness in preventing VTE, the...
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
Authors: Wang Y, Wang M, Ni Y, Liang Z Abstract Background: Venous thromboembolism (VTE) is a common complication in cancer patients. We aim to evaluate the effect and safety of direct oral anticoagulants (DOACs) as primary prophylaxis in ambulatory cancer patients.Methods: We conducted a literature search in PubMed, EMBASE and ClinicalTrials for studies that evaluated DOACs for thromboprophylaxis in cancer patients. RevMan 5.3 software was used for this meta-analysis.Results: Three randomized controlled trials (RCTs) with a total of 1465 patients were pooled in the meta-analysis. DOACs significantly reduced the sy...
Source: Hematology - Category: Hematology Tags: Hematology Source Type: research
Abstract In this concise review, we discuss some common clinical challenges in the management of patients with cancer-associated venous thromboembolism (VTE), a frequent complication in patients with cancer that increases morbidity and mortality. While direct oral anticoagulants (DOACs) have been established in clinical practice for anticoagulation in patients with VTE without cancer, their efficacy and safety in patients with cancer have not been assessed in randomized controlled trials until recently. The choice of the appropriate anticoagulant agent in the era of DOACs to treat patients with cancer-associated V...
Source: Hamostaseologie - Category: Hematology Authors: Tags: Hamostaseologie Source Type: research
This article reviews results from preclinical and healthy volunteer studies that illustrate the noteworthy properties of apixaban such as a proportional dose-response relationship, low daily fluctuation in plasma concentrations, and safety over a 10-fold dosing range. Additionally, the large phase III trials evaluating the safety and efficacy of apixaban compared to low molecular weight heparin (LMWH) overlapped with and followed by vitamin K antagonist (VKA) warfarin for the treatment and secondary prevention of VTE will be discussed. The key studies that have led to apixaban's current licensing and use will be highlighte...
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research
Abstract Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism, and preventing stroke in persons with atrial fibrillation. Direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation. Vitamin K antagonists are recommended for patients with mechanical valves and valvular atrial fibrillation. Vitamin K antagonists inhibit the production of vitamin K-related factors and require a minimum of five days overlap with parenteral anticoagulants, ...
Source: American Family Physician - Category: Primary Care Authors: Tags: Am Fam Physician Source Type: research
Researchers have spent many years developing improved medical treatments for pulmonary embolism (PE), such as development of the direct oral anticoagulants, outpatient management of PE and optimization of treatments for cancer-associated PE. Much of this research has focused on reducing venous thrombotic recurrence and reducing bleeding complications, with success measured in terms of absolute risk reduction. Evidence-based medicine assumes that reduction in a measurable untoward outcome translates into improved patient-centered care.
Source: Thrombosis Research - Category: Hematology Authors: Tags: Editorial Source Type: research
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