The etiology, diagnosis and treatment of venous thromboembolism Kraaijenhagen, R.A.
|
|
- Angela Nichols
- 6 years ago
- Views:
Transcription
1 UvADARE (Digital Academic Repository) The etiology, diagnosis and treatment of venous thromboembolism Kraaijenhagen, R.A. Link to publication Citation for published version (APA): Kraaijenhagen, R. A. (2000). The etiology, diagnosis and treatment of venous thromboembolism General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvADARE is a service provided by the library of the University of Amsterdam ( Download date: 31 Dec 2017
2 Chapter XIII Early discharge strategies following venous thrombosis Harry R. Biiller, Roderik A. Kraaijenhagen and Maria M.W. Koopman From the Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Vascular Medicine 3(1): 4750,
3 CHAPTER XIII Abstract Lowmolecularweight heparin therapy is administered subcutaneously, not intravenously. This has made possible the management of selected patients who have acute deep venous thrombosis as outpatients. Others can be treated with an abbreviated several day hospitalisation rather than the conventional 5 or more hospital days needed for administration of continuous intravenous unfractionated heparin. Two large studies, Tasman and a Canadian trial, have demonstrated the efficacy and safety of lowmolecularweight heparin in this setting. Now, the task is to develop guidelines for widespread application of these findings to daily clinical practice. However, successful home treatment will require intensive patients education as well as an extensive infrastructure of supportive nursing and physician services. Careful patient followup will be crucially important. Introduction It is current practice to treat patients with acute venous thrombosis with an initial course of continuous, intravenous unfractionated heparin. Oral anticoagulant therapy is starts concomitantly and continued for at least 3 months 1. Evidence from a series of randomised clinical trials has indicated that the use of unfractionated heparin (UFH) is absolutely necessary in the initial phase of treatment to prevent pulmonary embolism and recurrent venous thrombosis 2, that its dose should be adjusted to prolong the activated partial thromboplastin time into a desired therapeutic range to prevent recurrences 1 and that 5 days of heparin treatment is as effective and safe as 10 days 3 ' 4 (Table 1). Although twicedaily subcutaneous UFH, also in an adjusted dose, has been shown to be as effective and well tolerated as heparin given intravenously, the latter route administration is the most widely used 5. The need for dose adjustments of UFH, regardless of the mode of administration, is based on the large inter and nitreindividual variability of UFH pharmacodynamics and the relatively short halflife. The use of UFH for the treatment of acute deep vein thrombosis Table 1. Unfractionated heparin in the treatment of venous thrombosis. Initial fulldose heparin is absolutely required. Rapidly achieved therapeutic plasma concentrations reduce risk of recurrences. Subcutaneous adjusted dose heparin is equivalent to a continuous intravenous regimen. Shortterm (5 days) heparinization is as effective as longterm (10 days) treatment. 212
4 Early discharge strategies following venous thrombosis Table 2. Advantages of lowmolecularweight heparin compared with unfractionated heparin. Longer plasma halflife. Almost complete bioavailability. Less interaction with endothelial cells, plasma proteins and other blood cells. Reduced risk of osteoporosis and of heparininduced thrombocytopenia. suffers from the limitation that patients need to be admitted to hospital for the intravenous line and the necessary frequent laboratory monitoring and subsequent dose adjustments. Furthermore, the infusion limits patients' mobility and they are exposed to the risks of hospital acquired infections. Finally, this approach increases the treatment costs 6, The depolymerization of UFH yields lowmolecular weight heparins (LMWH) that have advantages over the parent compound. These include: a longer plasma halflife, an almost complete bioavailability after parenteral administration and much less interaction with plasma proteins resulting in a predictable doseresponse relationship 7 ' 8 (Table 2). As a result of these advantages, LMWH can be given subcutaneously, once or twice daily, in a dose that requires adjustment only for bodyweight, thereby obviating the need for laboratory control. Results from at least 13 welldesigned, randomised clinical trials comparing continuous, doseadjusted intravenous UFH with subcutaneous fixed dose LMWH in patients with acute deep vein thrombosis, have shown that this latter approach is at least as safe and effective as the traditional intravenous treatment 9. More recently, these findings have been confirmed in two large studies which also included patients with primary pulmonary embolism All these studies, however, were performed with patients treated entirely in hospital. The simplicity of treatment with LMWH in patients with acute venous thrombosis makes this therapy attractive for use out of hospital. Other inhospital services, such as administration of intravenous chemotherapy, analgesics, antibiotics or parenteral nutrition have been shown to be feasible when given at home. It seems, therefore, a logical development to transfer inhospital treatment of acute venous thrombosis patients with LMWH to treatment at home. The feasibility, efficacy, safety and costeffectiveness of such an approach was recently investigated in two large clinical studies 12,13. The results of these studies, which directly compared inhospital intravenous UFH with fixeddose subcutaneous LMWH home therapy in patients with proven symptomatic deep vein thrombosis, will be discussed in detail. Furthermore, the essential requirements for successful home treatment and the possible disadvantages of this approach will be reviewed. 213
5 CHAPTER XIII Home treatment with lowmolecularweight heparin Anticoagulant treatment for deep vein thrombosis aims to prevent symptomatic pulmonary embolism and recurrent thrombosis in the weeks to months following the initial event. This should be achieved with no excessive risk of bleeding. Consequently, in studies comparing anticoagulant treatment strategies, these outcomes should be the primary endpoints. Because all studies with LMWH therapy in venous thrombosis have been performed in a hospital setting, there is room for legitimate concern that efficacy may be compromised and that patients will become more apprehensive when treated away from a source of direct medical care. Two studies evaluated home treatment with LMWH. In both studies, the first one (the Tasman study) involving various centers in Europe, Australia and New Zealand and the second one based in Canadian centers, consecutive patients with documented, symptomatic, mainly proximal, deep vein thrombosis were randomised to receive either intravenous treatment with UFH in hospital or home treatment with subcutaneous LMWH The patients randomised to LMWH, were, when appropriate, discharged early from hospital or were not admitted at all. In the Tasman study, the changes in quality of life and the use of resources were also assessed. In both trials, patient selection criteria, study design and outcome definitions were comparable. Both studies also used an independent, blinded committee for adjudication of episodes of recurrent venous thromboembolism, major bleeding, as well as all deaths. In the Canadian study, patients were followed for 3 months, while this was 6 months in the Tasman trial. Two different LMWH preparations were used. The baseline clinical characteristics of the two study groups in both trials were comparable, as was the case for the comparison between the studies (Table 3). Although patients with symptoms of possible pulmonary embolism were excluded, Table 3. Baseline clinical characteristics in the Tasman and Canadian studies comparing lowmolecularweight heparin (LMWH) with unfractionated heparin (UFH) in patients with venous thrombosis. Number of patients Mean age ± SD (years) Male sex (%) previous thrombosis (%) Known cancer (%) Recent surgery (%) Tasman LMWH ± study" UFH Canadian LMWH ± study 12 UFH
6 Early discharge strategies following venous thrombosis Table 4. Recurrent venous thromboembolism (VTE), major bleeding and mortality in the Tasman and Canadian studies comparing lowmolecularweight heparin (LMWH) with unfractionated heparin (UFH) in patients with venous thrombosis. Number of patients Recurrent VTE 03 months 36 months All Major bleeding 014 days 1584 days All Mortality 03 months 36 months All Tasman LMWH 202 Number of patients (%) (6.9) (0.5) (6.9) study" UFH (8.6) (2.0) (8.1) Canadian study 12 LMWH UFH (5.3) (2.0) (4.5) 17 17(6.7) 3 0 3(1.2) 17 17(6.7) the clinical characteristics are representative for the usual patient with symptomatic deep vein thrombosis of the leg seen at a primary care diagnostic referral center. As illustrated in Table 4, symptomatic recurrent venous thromboembolism, confirmed by objective tests occurred with a frequency of 6.9% and 5.3% in patients treated with LMWH, compared with 8.6% and 6.7% in patients receiving UFH. It should, however, be noted that the duration of followup in the two studies was different. In boot studies the absolute difference in the rates of recurrence were slightly in favour of LMWH (Tasman study 1.7%: 95% CI ; Canadian study 1.4%: 95% CI ), allowing for the conclusion that this treatment strategy is at least as effective as the intravenous UFH regimen. Major bleeding was uncommon in both studies and also quite comparable between the two treatment regimens (Table 4). As has been noted before, LMWH therapy appears to be associated with a lower overall morality, compared with UFH This is mainly due to a reduction in mortality in those deep vein thrombosis patients with cancer. The validity of this observation and the mechanism for this effect is not certain and should be investigated in an appropriate study. Of the patients with venous thrombosis randomised to LMWH, about onethird to onehalf were treated entirely outside of hospital with either selfinjection or LMWH 215
7 CHAPTER XIII Table 5. Mean duration of initial treatment, hospitalization status and mean duration of hospital stay in the Tasman and Canadian studies comparing lowmolecularweight heparin (LMWH) with unfractionated heparin (UFH) in patients with venous thrombosis. Number of patients Tasman LMWH 202 Duration of initial treatment 6.5 ± 2.2 (days ± SD) Number ol patients (%) Hospitalization during treatment study 13 UFH ±1.8 Canadian study 12 LMWH UFH ± ±1.2 not admitted 72 (35) 120(49) 2(1) discharged after < 48h after > 48h entirely in hospital Mean duration of hospital (days) 44 (22) 36(18) 50 (25) stay (100) administration by family members (Table 5). In the Tasman study, which did not consider the possibility criterion, another 40% of patients were discharged after a brief stay in hospital. In both studies, approximately 25% of patients received their LMWH treatments entirely in hospital. The concern that patients might react negatively to treatment outside the hospital is refuted by the findings of the detailed quality of life assessments in the Tasman study. The indicators of quality of life, including emotional wellbeing and the amount of effort needed to cope with the disease, improved similarly over time in both treatment groups. Treatment with LMWH was associated with less impairment of physical activity and social functioning, indicating that the LMWH therapy allows for more activity and better functioning, without inducing a negative effect on mental wellbeing. The strategy of treating patients at home with LMMWH when feasible led to a 7080% reduction in hospital stay. The mean duration of hospital stay for all LMWH patients was 2.7 and 1.1. days in both studies, compared with 8.1 and 6.5 days for those treated with UFH (Table 5). Even when the savings in costs for the reduced hospital stay is corrected for the increase in costs associated with extra outpatient visits, telephone calls and additional support at home, the LMWH strategy for treatment of venous thrombosis is very costeffective
8 Early discharge strategies following venous thrombosis Requirements for successful home treatment If the results from other studies confirm the feasibility, efficacy and safety of LMWH therapy for venous thrombosis outside a hospital setting, programs should be set up for home treatment. These programs need to be developed by three parties at a regional level and may differ slightly from each other due to the local circumstances. The three parties include: (1) the departments or physicians, currently responsible for the treatment of patients with venous thrombosis; (2) the community facilities and personnel, such as primary care physicians, nurses and laboratories, which will (in part) become responsible for the home treatment program; and (3) patient organisations. Estimates from Canada and Europe have indicated that about 7085% of patients with acute deep vein thrombosis can be treated with LMWH home either after a brief stay in hospital or without being admitted at all 13,16. There are several essential requirements for the success of a home treatment program (Table 6). Guidelines need to be developed to decide whether a patient should be treated in hospital. Clearly, patients with a highrisk for hemorrhagic complications or those with serious comorbid conditions or obvious pulmonary embolism should not enter the home treatment program. Furthermore, patients need to be educated about what venous thrombosis is, its possible complications and which sideeffects are associated with anticoagulant therapy. Patient education material needs to be developed for this purpose. Those patients who do not understand these issues should be treated in hospital. They may, however, be discharged early if they subsequently feel more comfortable with the treatment. For home treatment, two strategies are available: selfinjection (or injection by family members) and nursing support. The great majority of patients prefer selfinjection and are able to do so, but efficient nursing support may be essential for elderly or otherwise incapacitated patients 13 ' 16. If a patient develops complications at home, a 24h service for medical consultation must be available. This could be the local hospital emergency room or the primary care physician. Finally, care outside the hospital increases pressure on community facilities to pro Table 6. Essential requirements for successful home treatment with lowmolecularweight heparin for venous thrombosis. Development of guidelines for selection of patients for home treatment. Availability of patient education brochure. Possibility for homecare services. Around the clock availability of emergency department facilities. Adequate oral anticoagulant therapy control and followup of patients. 217
9 CHAPTER XIII vide proper anticoagulant therapy and followup of patients for the possible underlying conditions associated with the venous thrombosis. These facilities need to have adequate resources and preparation for this task. Potential disadvantages of home treatment The introduction of LMWH therapy at home constitutes a major step forward in the treatment of patients with deep vein thrombosis. There are, however, several potential hazards. Because the clinical diagnosis is unreliable, the presence of the disease should be confirmed objectively in every patient to avoid unnecessary treatment. Furthermore, an adequate assessment of risk factors to explain the possible cause of thrombosis should be undertaken in each patient. This investigation should include a proper physical examination with subsequent laboratory or imaging tests, if appropriate, for the presence of malignant diseases or thrombophilia 17 ' 18. Finally, adequate control of and compliance with anticoagulant therapy should be guaranteed in the home treatment programs to avoid under and overtreatment. 218
10 Early discharge strategies following venous thrombosis References 1. Ginsberg JS. Management of venous thromboembolism. N Engl J Med 1996; 335: Brandjes DPM, Heijboer H, Büller HR et al. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal vein thrombosis. N Engl J Med 1992; 327: Gallus A, Jackaman J, Tillet J et al. Safety and efficacy of Warfarin started early after submassive venous thrombosis or pulmonary embolism. Lancet 1986; ii: Hull RD, Raskob GE, Rosenbloom D et al. Heparin for 5 days as compared with 10 days in the initial treatment of proximal vein thrombosis. N Engl J Med 1990; 322: Hommes DW, Bura A, Mazzolai L et al. Subcutaneous heparin compared with continuous intravenous heparin administration in the initial treatment of deep vein thrombosis. A metaanalysis. Ann Intern Med 1992; 116: Leape LJ, Brennan TA, Laird NM et al. The nature of adverse events in hospitalised patients: results of the Harvard Medical Practice Study II. N Engl J Med 1991; 324: Hirsh J, Levine MN. Low molecular weight heparin. Blood 1992; 79: Young E, Prins MH, Levine MN, Hirsh J. Heparin binding to plasma proteins. An important mechanism for heparin resistance. Thromb Haemost 1992; 67: Kuijer PMM, Prins MH, Büller HR. Lowmolecularweight heparins treatment of venous thromboembolism. In: Sasahara AA, Loscalzo J eds. Advances in therapeutic agents in thrombosis and thrombolysis. New York: M Dekker Inc., 1997: The Columbus Investigators. Lowmolecularweight heparin in the treatment of patients with venous thromboembolism. N Engl J Med 1997; 337: Simonneau G, Sors H, Charbonnier B et al, on behalf of the THÉSEE Study Group. A comparison of lowmolecularweight heparin with unfractionated heparin for acute pulmonary embolism. N Engl J Med 1997; 337: Levine MN, Gent M, Hirsh J et al. A comparison of lowmolecular weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep vein thrombosis. N Engl J Med 1996; 334: Koopman MMW, Prandoni P, Piovella F et al, on behalf of the TASMAN study 219
11 CHAPTER XIII group. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous lowmolecularweight heparin administered at home. N Engl J Med 1996; 334: Lensing AWA, Prins MH, Davidson BL, Hirsh J. Treatment of deep vein thrombosis with low molecular weight heparins, a metaanalysis. Arch Intern Med 1995; 155: van den Belt AGM, Bossuyt PMM, Prins MH, Gallus AS, Büller HR, on behalf of the Tasman Study Group. Replacing inpatient care by outpatient care in the treatment of deep venous thrombosis. A costminimisation analysis. Thromb Haemost 1998; 79: Wells PS, Kovacs MJ, Forgie MA, Bormanis J, Goudie D, Morrow B, Kovacs J. Outpatient treatmetn of deep venous thrombosis (DVT) with low molecular weight heparin. Blood 1996; 88 (10 suppl 1): 659 (abstract). 17. Heijboer H, Brandjes DPM, Büller HR, Sturk A, ten Cate JW. Deficiencies of coagulationinhibiting and fibrinolytic proteins in outpatients with deepvein thrombosis. N Engl J Med 1990; 323: Prandoni P, Lensing AWA, Büller HR et al, Deepvein thrombosis and the incidence of subsequent symptomatic cancer. N Engl I Med 1992; 327:
Review Low-molecular-weight heparins in the treatment of venous thromboembolism Walter Ageno and Menno V Huisman*
Review Low-molecular-weight heparins in the treatment of venous thromboembolism Walter Ageno and Menno V Huisman* University of Insubria, Varese, Italy, and *Leiden University Medical Centre, Leiden, The
More informationDeep vein thrombosis (DVT) is a pervasive LOW-MOLECULAR-WEIGHT HEPARIN IN THE TREATMENT OF ACUTE DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM *
LOW-MOLECULAR-WEIGHT HEPARIN IN THE TREATMENT OF ACUTE DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM * Geno J. Merli, MD ABSTRACT There are more than 170 000 hospital admissions each year for deep vein thrombosis
More informationThe management of venous thromboembolism has improved. Article
Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism A Randomized, Double-Blind, Controlled Trial
More informationUvA-DARE (Digital Academic Repository) Cancer, thrombosis and low-molecular-weight heparins Piccioli, A. Link to publication
UvA-DARE (Digital Academic Repository) Cancer, thrombosis and low-molecular-weight heparins Piccioli, A. Link to publication Citation for published version (APA): Piccioli, A. (2015). Cancer, thrombosis
More informationThyroid disease and haemostasis: a relationship with clinical implications? Squizzato, A.
UvA-DARE (Digital Academic Repository) Thyroid disease and haemostasis: a relationship with clinical implications? Squizzato, A. Link to publication Citation for published version (APA): Squizzato, A.
More informationSAFETY OF A PULMONARY EMBOLISM AMBULATORY TREATMENT PROGRAM
SAFETY OF A PULMONARY EMBOLISM AMBULATORY TREATMENT PROGRAM Mahir M. Hamad 1, MD, FRCP, Elrasheed A. Ellidir 1, MD, MRCP, Charlotte Routh 1, MD, MRCP, Siraj O. Wali 2, FACP, FCCP, and Vincent M. Connolly
More informationDEEP VEIN THROMBOSIS (DVT): TREATMENT
DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence-based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada
More informationCitation for published version (APA): van Es, N. (2017). Cancer and thrombosis: Improvements in strategies for prediction, diagnosis, and treatment
UvA-DARE (Digital Academic Repository) Cancer and thrombosis van Es, N. Link to publication Citation for published version (APA): van Es, N. (2017). Cancer and thrombosis: Improvements in strategies for
More informationUvA-DARE (Digital Academic Repository) Improving aspects of palliative care for children Jagt, C.T. Link to publication
UvA-DARE (Digital Academic Repository) Improving aspects of palliative care for children Jagt, C.T. Link to publication Citation for published version (APA): Jagt, C. T. (2017). Improving aspects of palliative
More informationResults from RE-COVER RE-COVER II RE-MEDY RE-SONATE EXECUTIVE SUMMARY
Assessment of the safety and efficacy of dabigatran etexilate (Pradaxa ) in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and the prevention of recurrent DVT and PE Results from
More informationThe etiology, diagnosis and treatment of venous thromboembolism Kraaijenhagen, R.A.
UvA-DARE (Digital Academic Repository) The etiology, diagnosis and treatment of venous thromboembolism Kraaijenhagen, R.A. Link to publication Citation for published version (APA): Kraaijenhagen, R. A.
More informationPrediction of toxicity in concurrent chemoradiation for non-small cell lung cancer Uijterlinde, W.I.
UvA-DARE (Digital Academic Repository) Prediction of toxicity in concurrent chemoradiation for non-small cell lung cancer Uijterlinde, W.I. Link to publication Citation for published version (APA): Uijterlinde,
More informationThe diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S.
UvA-DARE (Digital Academic Repository) The diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S. Link to publication Citation for published version (APA): Gibson, N. S.
More informationANTICOAGULANT treatment for deep-vein thrombosis
682 THE NEW ENGLAND JOURNAL OF MEDICINE March 14, 1996 TREATMENT OF VENOUS THROMBOSIS WITH INTRAVENOUS UNFRACTIONATED HEPARIN ADMINISTERED IN THE HOSPITAL AS COMPARED WITH SUBCUTANEOUS LOW- MOLECULAR-WEIGHT
More informationUvA-DARE (Digital Academic Repository) An electronic nose in respiratory disease Dragonieri, S. Link to publication
UvA-DARE (Digital Academic Repository) An electronic nose in respiratory disease Dragonieri, S. Link to publication Citation for published version (APA): Dragonieri, S. (2012). An electronic nose in respiratory
More informationAdministration of heparin has been
Thrombosis Research Paper Out of hospital treatment with subcutaneous low molecular weight heparin in patients with acute deep-vein thrombosis: a prospective study in daily practice Majida Zidane Leonard
More informationLow Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders
SURGICAL GRAND ROUNDS March 17 th, 2007 Low Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders Guillermo Escobar, M.D. LMWH vs UFH Jayer s sales pitch: FALSE LMW is
More informationAdvances in Abdominal Aortic Aneurysm Care - Towards personalized, centralized and endovascular care van Beek, S.C.
UvA-DARE (Digital Academic Repository) Advances in Abdominal Aortic Aneurysm Care - Towards personalized, centralized and endovascular care van Beek, S.C. Link to publication Citation for published version
More informationCitation for published version (APA): Wijkerslooth de Weerdesteyn, T. R. (2013). Population screening for colorectal cancer by colonoscopy
UvA-DARE (Digital Academic Repository) Population screening for colorectal cancer by colonoscopy de Wijkerslooth, T.R. Link to publication Citation for published version (APA): Wijkerslooth de Weerdesteyn,
More informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationMedical Patients: A Population at Risk
Case Vignette A 68-year-old woman with obesity was admitted to the Medical Service with COPD and pneumonia and was treated with oral corticosteroids, bronchodilators, and antibiotics. She responded well
More informationFixed-dose versus adjusted-dose low molecular weight heparin for the initial treatment of patients with deep venous thrombosis Job Harenberg, MD
Fixed-dose versus adjusted-dose low molecular weight heparin for the initial treatment of patients with deep venous thrombosis Job Harenberg, MD Patients with acute deep vein thrombosis (DVT) were treated
More informationUvA-DARE (Digital Academic Repository) Vascular factors in dementia and apathy Eurelings, Lisa. Link to publication
UvA-DARE (Digital Academic Repository) Vascular factors in dementia and apathy Eurelings, Lisa Link to publication Citation for published version (APA): Eurelings, L. S. M. (2016). Vascular factors in
More informationAnxiety disorders in children with autism spectrum disorders: A clinical and health care economic perspective van Steensel, F.J.A.
UvA-DARE (Digital Academic Repository) Anxiety disorders in children with autism spectrum disorders: A clinical and health care economic perspective van Steensel, F.J.A. Link to publication Citation for
More informationDirect Oral Anticoagulants (DOACs). Dr GM Benson Director NI Haemophilia Comprehensive Care Centre and Thrombosis Unit BHSCT
Direct Oral Anticoagulants (DOACs). Dr GM Benson Director NI Haemophilia Comprehensive Care Centre and Thrombosis Unit BHSCT OAC WARFARIN Gold standard DABIGATRAN RIVAROXABAN APIXABAN EDOXABAN BETRIXABAN
More informationDual-therapy stent technology for patients with coronary artery disease Kalkman, D.N.
UvA-DARE (Digital Academic Repository) Dual-therapy stent technology for patients with coronary artery disease Kalkman, D.N. Link to publication Citation for published version (APA): Kalkman, D. N. (2018).
More informationBuilding blocks for return to work after sick leave due to depression de Vries, Gabe
UvA-DARE (Digital Academic Repository) Building blocks for return to work after sick leave due to depression de Vries, Gabe Link to publication Citation for published version (APA): de Vries, G. (2016).
More informationAMORE (Ablative surgery, MOulage technique brachytherapy and REconstruction) for childhood head and neck rhabdomyosarcoma Buwalda, J.
UvA-DARE (Digital Academic Repository) AMORE (Ablative surgery, MOulage technique brachytherapy and REconstruction) for childhood head and neck rhabdomyosarcoma Buwalda, J. Link to publication Citation
More informationCitation for published version (APA): van Munster, B. C. (2009). Pathophysiological studies in delirium : a focus on genetics.
UvA-DARE (Digital Academic Repository) Pathophysiological studies in delirium : a focus on genetics van Munster, B.C. Link to publication Citation for published version (APA): van Munster, B. C. (2009).
More informationResults from Hokusai-VTE presented during ESC Congress 2013 Hot Line session and published in the New England Journal of Medicine
Press Release Daiichi Sankyo s Once-Daily Edoxaban Shows Comparable Efficacy and Superiority for the Principal Safety Endpoint Compared to Warfarin in a Phase 3 Study for the Treatment of Symptomatic VTE
More informationNon commercial use only. The treatment of venous thromboembolism with new oral anticoagulants. Background
Italian Journal of Medicine 2013; volume 7(s8):29-35 The treatment of venous thromboembolism with new oral anticoagulants Davide Imberti AUSL Piacenza, Italy ABSTRACT Traditional anticoagulants, such as
More informationClinical aspects of venous thromboembolism in special patient populations Bleker, S.M.
UvA-DARE (Digital Academic Repository) Clinical aspects of venous thromboembolism in special patient populations Bleker, S.M. Link to publication Citation for published version (APA): Bleker, S. M. (2017).
More informationGezinskenmerken: De constructie van de Vragenlijst Gezinskenmerken (VGK) Klijn, W.J.L.
UvA-DARE (Digital Academic Repository) Gezinskenmerken: De constructie van de Vragenlijst Gezinskenmerken (VGK) Klijn, W.J.L. Link to publication Citation for published version (APA): Klijn, W. J. L. (2013).
More informationCitation for published version (APA): Bartels, S. A. L. (2013). Laparoscopic colorectal surgery: beyond the short-term effects
UvA-DARE (Digital Academic Repository) Laparoscopic colorectal surgery: beyond the short-term effects Bartels, S.A.L. Link to publication Citation for published version (APA): Bartels, S. A. L. (2013).
More informationUvA-DARE (Digital Academic Repository) The artificial pancreas Kropff, J. Link to publication
UvA-DARE (Digital Academic Repository) The artificial pancreas Kropff, J. Link to publication Citation for published version (APA): Kropff, J. (2017). The artificial pancreas: From logic to life General
More informationIdentifying and evaluating patterns of prescription opioid use and associated risks in Ontario, Canada Gomes, T.
UvA-DARE (Digital Academic Repository) Identifying and evaluating patterns of prescription opioid use and associated risks in Ontario, Canada Gomes, T. Link to publication Citation for published version
More informationCitation for published version (APA): Mac Gillavry, M. R. (2001). Some understanding of diagnostic tests for pulmonary embolism
UvA-DARE (Digital Academic Repository) Some understanding of diagnostic tests for pulmonary embolism Mac Gillavry, M.R. Link to publication Citation for published version (APA): Mac Gillavry, M. R. (2001).
More informationCitation for published version (APA): Braakhekke, M. W. M. (2017). Randomized controlled trials in reproductive medicine: Disclosing the caveats
UvA-DARE (Digital Academic Repository) Randomized controlled trials in reproductive medicine Braakhekke, M.W.M. Link to publication Citation for published version (APA): Braakhekke, M. W. M. (2017). Randomized
More informationCitation for published version (APA): Douma, R. A. (2010). Pulmonary embolism: advances in diagnosis and prognosis
UvA-DARE (Digital Academic Repository) Pulmonary embolism: advances in diagnosis and prognosis Douma, R.A. Link to publication Citation for published version (APA): Douma, R. A. (2010). Pulmonary embolism:
More informationCitation for published version (APA): Luijendijk, P. (2014). Aortic coarctation: late complications and treatment strategies.
UvA-DARE (Digital Academic Repository) Aortic coarctation: late complications and treatment strategies Luijendijk, P. Link to publication Citation for published version (APA): Luijendijk, P. (2014). Aortic
More informationFecal Microbiota Transplantation: Clinical and experimental studies van Nood, E.
UvA-DARE (Digital Academic Repository) Fecal Microbiota Transplantation: Clinical and experimental studies van Nood, E. Link to publication Citation for published version (APA): van Nood, E. (2015). Fecal
More informationUse of the comprehensive geriatric assessment to improve patient-centred care in complex patient populations Parlevliet, J.L.
UvA-DARE (Digital Academic Repository) Use of the comprehensive geriatric assessment to improve patient-centred care in complex patient populations Parlevliet, J.L. Link to publication Citation for published
More informationEXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS
EXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS Samuel Z. Goldhaber, MD Director, VTE Research Group Cardiovascular Division Brigham and Women s Hospital Professor of Medicine Harvard Medical
More informationCharacterizing scaphoid nonunion deformity using 2-D and 3-D imaging techniques ten Berg, P.W.L.
UvA-DARE (Digital Academic Repository) Characterizing scaphoid nonunion deformity using 2-D and 3-D imaging techniques ten Berg, P.W.L. Link to publication Citation for published version (APA): ten Berg,
More informationUvA-DARE (Digital Academic Repository) Cancer, thrombosis and low-molecular-weight heparins Piccioli, A. Link to publication
UvA-DARE (Digital Academic Repository) Cancer, thrombosis and low-molecular-weight heparins Piccioli, A. Link to publication Citation for published version (APA): Piccioli, A. (2015). Cancer, thrombosis
More informationClinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B.
UvA-DARE (Digital Academic Repository) Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. Link to publication Citation for published version (APA): Post, B. (2009). Clinimetrics,
More informationComparison between Critical Pathway Guidelines and Management of Deep-Vein Thrombosis: Retrospective Cohort Study
41(2):163-167,2000 CLINICAL SCIENCES Comparison between Critical Pathway Guidelines and Management of Deep-Vein Thrombosis: Retrospective Cohort Study Nikša Vuèiæ, Nada Lang, Stjepan Baliæ, Vladimir Pilaš,
More informationLMWH <.05), (1.1% 10%; P
Venographic comparison of subcutaneous low molecular weight heparin with oral anticoagulant therapy in the long-term treatment of deep venous thrombosis Jose A. Gonzalez-Fajardo, MD, Emilio Arreba, MD,
More informationCitation for published version (APA): Donker, M. (2014). Improvements in locoregional treatment of breast cancer
UvA-DARE (Digital Academic Repository) Improvements in locoregional treatment of breast cancer Donker, Mila Link to publication Citation for published version (APA): Donker, M. (2014). Improvements in
More informationFamilial hypercholesterolemia in childhood: diagnostics, therapeutical options and risk stratification Rodenburg, J.
UvADARE (Digital Academic Repository) Familial hypercholesterolemia in childhood: diagnostics, therapeutical options and risk stratification Rodenburg, J. Link to publication Citation for published version
More informationCitation for published version (APA): Douma, R. A. (2010). Pulmonary embolism: advances in diagnosis and prognosis
UvA-DARE (Digital Academic Repository) Pulmonary embolism: advances in diagnosis and prognosis Douma, R.A. Link to publication Citation for published version (APA): Douma, R. A. (2010). Pulmonary embolism:
More informationPULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT
PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT OBJECTIVE: To provide a diagnostic algorithm and treatment options for patients with acute pulmonary embolism (PE). BACKGROUND: Venous thromboembolism (VTE)
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Single Technology Appraisal (STA)
Thank you for agreeing to give us a statement on your organisation s view of the technology and the way it should be used in the NHS. Healthcare professionals can provide a unique perspective on the technology
More informationUvA-DARE (Digital Academic Repository) Marfan syndrome: Getting to the root of the problem Franken, Romy. Link to publication
UvA-DARE (Digital Academic Repository) Marfan syndrome: Getting to the root of the problem Franken, Romy Link to publication Citation for published version (APA): Franken, R. (2016). Marfan syndrome: Getting
More informationDiagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism Summary Number 68 Overview Venous thromboembolism
More informationUvA-DARE (Digital Academic Repository) Falling: should one blame the heart? Jansen, Sofie. Link to publication
UvA-DARE (Digital Academic Repository) Falling: should one blame the heart? Jansen, Sofie Link to publication Citation for published version (APA): Jansen, S. (2015). Falling: should one blame the heart?
More informationCitation for published version (APA): Mac Gillavry, M. R. (2001). Some understanding of diagnostic tests for pulmonary embolism
UvA-DARE (Digital Academic Repository) Some understanding of diagnostic tests for pulmonary embolism Mac Gillavry, M.R. Link to publication Citation for published version (APA): Mac Gillavry, M. R. (2001).
More informationUvA-DARE (Digital Academic Repository) Malaria during pregnancy in Rwanda Rulisa, S. Link to publication
UvA-DARE (Digital Academic Repository) Malaria during pregnancy in Rwanda Rulisa, S. Link to publication Citation for published version (APA): Rulisa, S. (2014). Malaria during pregnancy in Rwanda General
More informationCitation for published version (APA): Douma, R. A. (2010). Pulmonary embolism: advances in diagnosis and prognosis
UvA-DARE (Digital Academic Repository) Pulmonary embolism: advances in diagnosis and prognosis Douma, R.A. Link to publication Citation for published version (APA): Douma, R. A. (2010). Pulmonary embolism:
More informationTobacco control policies and socio-economic inequalities in smoking cessation Bosdriesz, J.R.
UvA-DARE (Digital Academic Repository) Tobacco control policies and socio-economic inequalities in smoking cessation Bosdriesz, J.R. Link to publication Citation for published version (APA): Bosdriesz,
More informationTreatment Options and How They Work
Treatment Options and How They Work Robin Offord Director of Clinical Pharmacy UCL Hospitals NHS Foundation Trust robin.offord@uclh.nhs.uk Introducing the term anticoagulant... What they do Inhibit the
More informationCancer Associated Thrombosis: six months and beyond. Farzana Haque Hull York Medical School
Cancer Associated Thrombosis: six months and beyond Farzana Haque Hull York Medical School Disclosure I have no disclosure The Challenge of Anticoagulation in Patients with Venous Thromboembolism and Cancer
More informationIron and vitamin D deficiency in children living in Western-Europe Akkermans, M.D.
UvA-DARE (Digital Academic Repository) Iron and vitamin D deficiency in children living in Western-Europe Akkermans, M.D. Link to publication Citation for published version (APA): Akkermans, M. D. (2017).
More informationDaiichi Sankyo s Once-Daily Lixiana
Daiichi Sankyo s Once-Daily Lixiana (edoxaban) Receives Positive CHMP Opinion for the Prevention of Stroke and Systemic Embolism in Non-Valvular Atrial Fibrillation and for the Treatment and Prevention
More informationDeep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H
Deep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H Authors' objectives To systematically review the incidence of deep vein
More informationThis chapter will describe the effectiveness of antithrombotic
Antithrombotic Therapy for Venous Thromboembolic Disease The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Harry R. Büller, MD, Chair; Giancarlo Agnelli, MD; Russel D. Hull, MBBS,
More informationBath, Philip M.W. and England, Timothy J. (2009) Thighlength compression stockings and DVT after stroke. Lancet. ISSN (In Press)
Bath, Philip M.W. and England, Timothy J. (2009) Thighlength compression stockings and DVT after stroke. Lancet. ISSN 0140-6736 (In Press) Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/1087/1/lancet_clots_1_20090522_4.pdf
More informationThe diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S.
UvA-DARE (Digital Academic Repository) The diagnosis and prognosis of venous thromboembolism : variations on a theme Gibson, N.S. Link to publication Citation for published version (APA): Gibson, N. S.
More informationCanadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC
Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC 1 st workshop: update to VTE guidelines in 2016 2 nd workshop: VTE controversies + new horizons André Roussin MD, FRCP, CSPQ CHUM
More informationUvA-DARE (Digital Academic Repository) The systemic right ventricle van der Bom, T. Link to publication
UvA-DARE (Digital Academic Repository) The systemic right ventricle van der Bom, T. Link to publication Citation for published version (APA): van der Bom, T. (2014). The systemic right ventricle. General
More informationA Review of the Role of Non-Vitamin K Oral Anticoagulants in the Acute and Long-Term Treatment of Venous Thromboembolism
Cardiol Ther (2018) 7:1 13 https://doi.org/10.1007/s40119-018-0107-0 REVIEW A Review of the Role of Non-Vitamin K Oral Anticoagulants in the Acute and Long-Term Treatment of Venous Thromboembolism Andrew
More informationUvA-DARE (Digital Academic Repository) Genetic basis of hypertrophic cardiomyopathy Bos, J.M. Link to publication
UvA-DARE (Digital Academic Repository) Genetic basis of hypertrophic cardiomyopathy Bos, J.M. Link to publication Citation for published version (APA): Bos, J. M. (2010). Genetic basis of hypertrophic
More informationPatients with cancer are at a greater risk of developing venous thromboembolism than non-cancer patients, partly due to the 1
CANCER ASSOCIATED THROMBOSIS TREATMENT Patients with cancer are at a greater risk of developing venous thromboembolism than non-cancer patients, partly due to the 1 ability of tumour cells to activate
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/20073 holds various files of this Leiden University dissertation. Author: Zondag, Wendy Title: Pulmonary embolism : outpatient treatment and risk stratification
More informationORIGINAL INVESTIGATION. Clinical Outcome and Cost of Hospital vs Home Treatment of Proximal Deep Vein Thrombosis With a Low-Molecular-Weight Heparin
Clinical Outcome and Cost of Hospital vs Treatment of Proximal Deep Vein Thrombosis With a Low-Molecular-Weight Heparin The Vascular Midi-Pyrenees Study ORIGINAL INVESTIGATION Henri Boccalon, MD; Antoine
More informationMonitoring of unfractionated heparin in critically ill patients
REVIEW Monitoring of unfractionated heparin in critically ill patients R. Aarab 1*, J. van Es 1, A.C.J.M. de Pont 2, M.B. Vroom 2, S. Middeldorp 1 Department of 1 Vascular Medicine and 2 Intensive Care,
More informationEnzyme replacement therapy in Fabry disease, towards individualized treatment Arends, M.
UvA-DARE (Digital Academic Repository) Enzyme replacement therapy in Fabry disease, towards individualized treatment Arends, M. Link to publication Citation for published version (APA): Arends, M. (2017).
More informationincidence of cancer-associated thrombosis (CAT) is further increased by additional risk factors such as chemotherapeutic 2
CANCER ASSOCIATED THROMBOSIS TREATMENT Patients with cancer are at a greater risk of developing venous thromboembolism than non-cancer patients, partly due to the ability of tumour cells to activate the
More informationDeep Vein Thrombosis: Can a Second Sonographic Examination Be Avoided?
Alfonsa Friera 1 Nuria R. Giménez 2 Paloma Caballero 1 Pilar S. Moliní 2 Carmen Suárez 2 Received August 15, 2001; accepted after revision October 16, 2001. 1 Radiology Department, Hospital de la Princesa,
More informationCitation for published version (APA): Parigger, E. M. (2012). Language and executive functioning in children with ADHD Den Bosch: Boxpress
UvA-DARE (Digital Academic Repository) Language and executive functioning in children with ADHD Parigger, E.M. Link to publication Citation for published version (APA): Parigger, E. M. (2012). Language
More informationAntimicrobial drug resistance at the human-animal interface in Vietnam Nguyen, V.T.
UvA-DARE (Digital Academic Repository) Antimicrobial drug resistance at the human-animal interface in Vietnam Nguyen, V.T. Link to publication Citation for published version (APA): Nguyen, V. T. (2017).
More informationFunctional abdominal pain disorders in children: therapeutic strategies focusing on hypnotherapy Rutten, J.M.T.M.
UvA-DARE (Digital Academic Repository) Functional abdominal pain disorders in children: therapeutic strategies focusing on hypnotherapy Rutten, J.M.T.M. Link to publication Citation for published version
More informationOperational research on implementation of tuberculosis guidelines in Mozambique Brouwer, Miranda
UvA-DARE (Digital Academic Repository) Operational research on implementation of tuberculosis guidelines in Mozambique Brouwer, Miranda Link to publication Citation for published version (APA): Brouwer,
More informationBACKGROUND METHODS RESULTS CONCLUSIONS
CHAPTER 5 The combination of a normal D-dimer concentration and a non-high pretest clinical probability score is a safe strategy to exclude deep venous thrombosis R.E.G. Schutgens 1, P. Ackermark 2, F.J.L.M.
More informationKawasaki disease: Studies on etiology, treatment and long-term follow-up Tacke, C.E.A.
UvA-DARE (Digital Academic Repository) Kawasaki disease: Studies on etiology, treatment and long-term follow-up Tacke, C.E.A. Link to publication Citation for published version (APA): Tacke, C. E. A. (2014).
More informationTreatment of venous thromboembolism: Adherence to guidelines and impact of physician knowledge, attitudes, and beliefs
From the American Venous Forum Treatment of venous thromboembolism: Adherence to guidelines and impact of physician knowledge, attitudes, and beliefs Joseph A. Caprini, MD, a Victor F. Tapson, MD, b Thomas
More informationUvA-DARE (Digital Academic Repository) Toothbrushing efficacy Rosema, N.A.M. Link to publication
UvA-DARE (Digital Academic Repository) Toothbrushing efficacy Rosema, N.A.M. Link to publication Citation for published version (APA): Rosema, N. A. M. (2015). Toothbrushing efficacy. General rights It
More informationHandbook for Venous Thromboembolism
Handbook for Venous Thromboembolism Gregory Piazza Benjamin Hohlfelder Samuel Z. Goldhaber Handbook for Venous Thromboembolism Gregory Piazza Cardiovascular Division Harvard Medical School Brigham and
More informationVenous Thromboembolism Prophylaxis
Approved by: Venous Thromboembolism Prophylaxis Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: Date Approved January
More informationUvA-DARE (Digital Academic Repository) Functional defecation disorders in children Kuizenga-Wessel, S. Link to publication
UvA-DARE (Digital Academic Repository) Functional defecation disorders in children Kuizenga-Wessel, S. Link to publication Citation for published version (APA): Kuizenga-Wessel, S. (2017). Functional defecation
More informationORIGINAL INVESTIGATION. Challenges to the Effective Use of Unfractionated Heparin in the Hospitalized Management of Acute Thrombosis
ORIGINAL INVESTIGATION Challenges to the Effective Use of Unfractionated Heparin in the Hospitalized Management of Acute Thrombosis Elaine M. Hylek, MD, MPH; Susan Regan, PhD; Lori E. Henault, MPH; Margaret
More informationCitation for published version (APA): van der Paardt, M. P. (2015). Advances in MRI for colorectal cancer and bowel motility
UvA-DARE (Digital Academic Repository) Advances in MRI for colorectal cancer and bowel motility van der Paardt, M.P. Link to publication Citation for published version (APA): van der Paardt, M. P. (2015).
More informationPulmonary embolism: Acute management. Cecilia Becattini University of Perugia, Italy
Pulmonary embolism: Acute management Cecilia Becattini University of Perugia, Italy Acute pulmonary embolism: Acute management Diagnosis Risk stratification Treatment Non-high risk PE: diagnosis 3-mo VTE
More informationThe New England Journal of Medicine
The New England Journal of Medicine Copyright, 1997, by the Massachusetts Medical Society VOLUME 337 S EPTEMBER 4, 1997 NUMBER 10 LOW-MOLECULAR-WEIGHT HEPARIN IN THE TREATMENT OF PATIENTS WITH VENOUS THROMBOEMBOLISM
More informationVenous Thromboembolism National Hospital Inpatient Quality Measures
Venous Thromboembolism National Hospital Inpatient Quality Measures Presentation Overview Review venous thromboembolism as a new mandatory measure set Outline measures with exclusions and documentation
More informationUvA-DARE (Digital Academic Repository)
UvA-DARE (Digital Academic Repository) Superinfection with drug-resistant HIV is rare and does not contribute substantially to therapy failure in a large European cohort Bartha, I.; Assel, M.; Sloot, P.M.A.;
More informationNICE Guidance: Venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital 1
The College of Emergency Medicine Patron: HRH The Princess Royal Churchill House Tel +44 (0)207 404 1999 35 Red Lion Square Fax +44 (0)207 067 1267 London WC1R 4SG www.collemergencymed.ac.uk CLINICAL EFFECTIVENESS
More informationAcute and long-term treatment of PE. Cecilia Becattini University of Perugia
Acute and long-term treatment of PE Cecilia Becattini University of Perugia Acute and long-term treatment of VTE What is the optimal acute phase treatment for the patient? Intravenous thrombolysis One
More informationInflammation in chronic obstructive pulmonary disease : its assessment and the effects of corticosteroids Boorsma, M.
UvA-DARE (Digital Academic Repository) Inflammation in chronic obstructive pulmonary disease : its assessment and the effects of corticosteroids Boorsma, M. Link to publication Citation for published version
More information