UNIVERSITA DI PADOVA. Un tema particolare (II): Le trombosi venose in pediatria
|
|
- Emil Gilbert
- 6 years ago
- Views:
Transcription
1 UNIVERSITA DI PADOVA Un tema particolare (II): Le trombosi venose in pediatria Elena Campello Dipartimento di Medicina Università di Padova Bologna, 6 Novembre 2015
2 Introduction Pediatric thrombosis: - has become a substantial health hazard - may be associated with significant morbidity and mortality - additional impact imposed on the child s family members - greater life expectancy compared with affected elderly - lack of large carefully conducted clinical trials - necessity for improved diagnosis, better definition of outcomes, adapted treatment and prophylactic regimens newer anticoagulant drugs
3 Incidence of VTE in pediatric patients Canadian Registry /10,000 children per year 5.3/10,000 hospital admission Indicendence now 1/10,000 children per year 42-58/10,000 hospital admissions Andrew et al. Blood 1994 Kim et al. J Pediatr Orthop 2014 Raffini et al, Pediatrics 2009
4 VTE Admissions Over Time P < Raffini et al. Pediatrics 2009;124:1001-8
5 The annual rate of VTE increased by 70% [from 34 to 58 cases per hospital admissions (P.001)]. This increase was observed in neonates, infants, children, and adolescents.
6 Reason for increasing incidence Increasing use of CVC for supportive care Better imaging techniques for thrombus detection Increasing awareness of the problem Increasing incidence of critically sick children
7 Age distribution of thrombotic events in published registries from the UK (BPSU), Canada and The Netherlands (DPSU) Chalmers et al., Thrombosis Research 2006
8 RITI: systemic venous TE
9 Sites of thrombosis in child Chalmers et al., Thrombosis Research 2006
10 Etiology and risk factors 1. Endothelial damage Central venous catheters, ventricular-atrial shunts.. Sepsis Trauma Antiphospholipid antibodies Inflammatory conditions 2. Disruption of the laminar blood flow or stasis Post-operative states Immobility Anatomical variants Complex congenital heart disease or cardiomyopathy Total parentaral nutrition 3. Hypercoagulable state Inherited (PC,PS,AT deficiency, FVL, PT20210A, hyperhomocysteine) Acquired (infections, malignancy, pregnancy/hormonal therapy, antiphospholipid antibodies, medications) Pediatric thombotic disorders, edited by Goldenberg NA and Manco-Jhonson MJ, Cambrudge Medicine 2015
11 Risk factors in children True idiopathic VTE, which implies an absence of of either a provoking risk factor or an undelying prothrombotic condition, is rare in children. The majority of VTE is associated with an underlying associated disorder 76.2% Pediatric thombotic disorders, edited by Goldenberg NA and Manco-Jhonson MJ, Cambrudge Medicine 2015
12 Etiology and risk factors Chalmers et al., Thrombosis Research 2006
13 Central venous lines are associated with over 90% of deep vein thrombosis in neonates and 60% of children Neonate Child Adult
14 The number of risk factors in children with deep vein thrombosis and/or pulmonary embolism Number of risk factors
15 CVC-related thrombosis Significant increase in incidence associated with the following risk factors: - Increasing age - Advanced renal disease - Dyalisis - Inflammatory bowel disease - Total parenteral nutrition Smitherman et al. Hosp Pediatr 2015
16 Haematologica 2015
17 RITI: systemic venous TE
18
19 Inherited thrombophilia and RECURRENT thrombotic event in children NO NO NO Young G et al. Circulation 2008; 118:
20 Albisetti et al studied 114 children with malignancies No association between thrombophilia and CVC-related thrombosis KIDs with Catheter associated Study studied 90 children with heart disease no association between thrombophilic factors and CVC-related VTE
21
22
23 Diagnosis
24
25 D-Dimer in children Only 1 retrspective study in patients < 21 yrs (Strouse JJ et al. AmJ Hematol 2009) sensitivity 92%, specificity 57%
26
27 RITI: systemic venous TE
28 Chest 2012 First VTE standard approach First VTE idiopathic 6-12 months VKA
29 Chest 2012 Secondary VTE 3 months Ongoing reversible risk factor beyond 3 months (therapeutic or prophylactic)
30 Chest 2012 Recurrent idiopathic VTE indefinite - Recurrent secondary VTE, reversible risk factor at least 3 months (until resolution of risk situation)
31 Journal of Thrombosis and haemostasis 2015
32 -VTE and CVC not required removal after 3-5 days treatment -VTE and CVC required and functioning anticoagulation for 3 months + prophylactic VKA or LMWH - If recurrent VTE therapeutic until removal Chest 2012
33 Chest 2012 Acquired and congenital thrombophilia
34 Thrombophilia testing in symptomatic children Universal thrombophilia testing after a first episode of DVT in children is not cost-effective However Some inherited thrombophilias have been associated with increased VTE recurrance anticoagulation duration Therapeutic discussions and decision-making with patients/parents Thromboprophylaxis for adolescents in high-risk situations or counseling for females considering contraception
35 Thrombophilia testing in symptomatic children Results should be interpreted by an experienced physician Adolescent females are most likely to benefit from this information
36 Thrombolysis In children with VTE, we suggest that thrombolysis therapy be used only for lifeor limb-threatening thrombosis (Grade 2C). If thrombolysis is used in the presence of physiologically low levels or pathologic deficiencies of plasminogen, we suggest supplementation with plasminogen (Grade 2C). In children with VTE in whom thrombolysis is used, we suggest systemic thrombolysis or catheter-directed thrombolysis, depending on institutional experience and, in the latter case, technical feasibility.
37 Thrombectomy and IVC filters In children with life-threatening VTE, we suggest thrombectomy (Grade 2C) followed by anticoagulant therapy as for children with first VTE (Grade 2C). In children > 10 kg body weight with lower-extremity VTE and a contraindication to anticoagulation, we suggest placement of a retrievable IVC filter (Grade 2C). In children who receive a filter, we suggest that the filter be removed as soon as possible if thrombosis is not present in the basket of the filter and when contraindication to anticoagulation is resolved (Grade 2C). In children who receive an IVC filter, we recommend appropriate anticoagulation for VTE as soon as the contraindication to anticoagulation is resolved (Grade 1C).
38 PRIMARY THROMBOPROPHYLAXIS IN CHILDREN
39 65% decrease in incidence of VTE in patients who were divided into low-and high-risk categories based on thrombotic and bleeding risk.
40 A risk score of 3 or more identified high-risk children at a sensitivity of 70% and specificity of 80% and AUC of (95% confidence interval, ).
41 We did not find evidence that thromboprophylaxis reduced the risk of CVC-related DVT in children. An adequately powered RCT that can detect a modest, clinically significant reduction in the frequency of DVT is needed to determine the efficacy of thromboprophylaxis against CVC-related DVT in children
42 1. The use of physical methods for VTE risk reduction should be considered in older children and adolescents who are at increased risk of VTE (Grade 1C). 2. Children, particularly adolescents, with multiple risk factors for VTE should be considered for thromboprophylaxis with LMWH (Grade 2C). 3. Primary antithrombotic prophylaxis is not recommended in children with cancer and CVL (Grade 2C). 4. Where possible, CVLs should not be placed in the femoral or subclavian sites, particularly when there is a high risk of thrombosis (Grade 1B). 5. For neonates with CVLs, we recommend to maintain CVL patency with UH continuous infusion at 0.5 u/kg/h over no prophylaxis (Grade 1A) or intermittent local thrombolysis (Grade 2C). 6. For children with short- or medium-term CVLs, we recommend against the use of routine systemic thromboprophylaxis (Grade 1B).
43 Primary prophylaxis in children: open questions Increase request for prophylaxis Protocols like adults after puberty? (BMI?) Candidates to heparin prophylaxis: Neonates with diseases and CVC? Thrombophylic children who undergo major or orthopedic surgery? Increased use of non-pharmacological thromboprophylaxis (elastic stockings? Intermittent pneumatic compression?) Role for new drugs in the prophylaxis of VTE Needs for Pediatrics Thrombosis/Hemostasis Centers in Hospitals Need for a Registry for the identification of children at risk (RITI)
44
45
46 The exposures were well tolerated 2 studies reported a combined total of 76 NOA exposures to poison control centers (rivaroxaban and dabigatran) 3 children experienced coagulopathies
47 Conclusions DTV ha become an increasingly recognised complication in children Most of the reccomandation for diagnosis and management are based on extrapolations from adults Anticoagulation is the standard of care and risk stratification algorithms for hospitalized children that include consideration of thromboprophylaxis have been proposed by several publications.
48 Conclusions The present findings on recent published studies and registered trials in pediatric VTE mark an ongoing period of remarkable activity and advancement in the field of pediatric VTE (standard of care, long-term outcome, newer antithrombotic approaches)
49 Grazie per l attenzione! Clinical staff: Paolo Simioni Luca Spiezia Daniele Tormene Fabio Dalla Valle Elena Campello Sara Maggiolo Laboratory staff: Claudia M. Radu Cristiana Bulato Sabrina Gavasso Patrizia Zerbinati Mariangela Fadin Graziella Saggiorato Francesca Sartorello The Anatomical Theatre University of Padua
VTE in Children: Practical Issues
VTE in Children: Practical Issues Wasil Jastaniah MBBS,FAAP,FRCPC Consultant Pediatric Hem/Onc/BMT May 2012 Top 10 Reasons Why Pediatric VTE is Different 1. Social, ethical, and legal implications. 2.
More informationVenous Thromboembolism. Prevention
Venous Thromboembolism Prevention August 2010 Venous Thromboembloism Prevention 1 1 Expected Practice Assess all patients upon admission to the ICU for risk factors of venous thromboembolism (VTE) and
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationMabel Labrada, MD Miami VA Medical Center
Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and
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 informationHow long to continue anticoagulation after DVT?
How long to continue anticoagulation after DVT? Dr. Nihar Ranjan Pradhan M.S., DNB (Vascular Surgery), FVES(UK) Consultant Vascular Surgeon Apollo Hospital, Jubilee Hills, Hyderabad (Formerly Faculty in
More informationDVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the
More informationDubbi e certezze nella gestione delle emorragie con metodiche point-of-care
Sessione Educazionale 4 : Gestione del paziente emorragico Dubbi e certezze nella gestione delle emorragie con metodiche point-of-care P. Simioni Università di Padova hemostasis Vascular phase Platelet
More informationTreatment of Pediatric Venous Thromboembolism
Treatment of Pediatric Venous Thromboembolism An Educational Slide Set American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism Slide set authors: Eric Tseng MD, MScCH, University
More information1. SCOPE of GUIDELINE:
Page 1 of 35 CLINICAL PRACTICE GUIDELINE: Venous Thromboembolism (VTE) Prevention Guideline: Thromboprophylaxis AUTHORIZATION: VP, Medicine Date Approved: May 17, 2012 Date Revised: Vancouver Coastal Health
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 informationDraft Agreed by Cardiovascular Working Party 28 September Adoption by CHMP for release for consultation 12 October 2017
1 2 3 4 5 6 7 8 9 10 12 October 2017 EMA/230866/2017 Committee for Medicinal Products for Human Use (CHMP) Concept paper on the need for a paediatric addendum of the guideline on clinical investigation
More informationCURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired
More informationTop 5 (or so) Hematology Consults. Tom DeLoughery, MD FACP FAWM. Oregon Health and Sciences University DISCLOSURE
Top 5 (or so) Hematology Consults Tom FACP FAWM Oregon Health and Sciences University DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant/Research none 1 What I am Talking About
More informationPrevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales
Prevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales Merimbula, 6 th November 2010 University of Sydney Department of Surgery Westmead Hospital
More informationTHROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY
THROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY OBJECTIVE: To outline a practical approach for the prevention of venous thromboembolism (VTE) in patients undergoing non-orthopedic surgery. BACKGROUND: VTE is
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More informationVENOUS THROMBOEMBOLISM: DURATION OF TREATMENT
VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT OBJECTIVE: To provide guidance on the recommended duration of anticoagulant therapy for venous thromboembolism (VTE). BACKGROUND: Recurrent episodes of VTE
More informationINDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY
INDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY N.E. Pearce INTRODUCTION Preventable death Cause of morbidity and mortality Risk factors Pulmonary embolism
More informationRisk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD
Risk factors for DVT Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationVenous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD
Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Risk factors for DVT Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationTHROMBOPHILIA TESTING: PROS AND CONS SHANNON CARPENTER, MD MS CHILDREN S MERCY HOSPITAL KANSAS CITY, MO
THROMBOPHILIA TESTING: PROS AND CONS SHANNON CARPENTER, MD MS CHILDREN S MERCY HOSPITAL KANSAS CITY, MO DISCLAIMER I m a pediatrician I will be discussing this issue primarily from a pediatric perspective
More informationClinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden
Clinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden Clinical Policy Number: 05.01.03 Effective Date: January 1, 2016 Initial Review Date: July 15, 2015 Most Recent Review Date:
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 informationDuration of Anticoagulant Therapy. Linda R. Kelly PharmD, PhC, CACP September 17, 2016
Duration of Anticoagulant Therapy Linda R. Kelly PharmD, PhC, CACP September 17, 2016 Conflicts of Interest No conflicts of interest to report Objectives At the end of the program participants will be
More informationComparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project
Comparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project Dr. Jonathan Laxton, FRCPC, R5 GIM University of Manitoba
More informationDEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES
DEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES Jose M. Borromeo M.D. Vascular Surgeon Iowa Heart Center Disclosures: AstraZeneca Pharmaceuticals Cook CVRx LeMaitre Vascular,
More informationVenous thromboembolic diseases: diagnosis, management and thrombophilia testing (2012) NICE guideline CG144
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (2012) NICE guideline CG144 Appendix A: Summary of new evidence from Summary of evidence from previous year Diagnosis Diagnostic
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 informationImplications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach
Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach Prof. I. Baumgartner Head Clinical and Interventional Angiology About the ACCP guidelines Widely
More informationPREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM
PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM International Consensus Statement 2013 Guidelines According to Scientific Evidence Developed under the auspices of the: Cardiovascular Disease Educational
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 informationVenous Thromboembolic Disease Update
Canadian Society of Internal Medicine Annual Meeting Calgary, Alberta, October 2014 Venous Thromboembolic Disease Update Benjamin Bell, MD FRCPC James Douketis, MD FRCPC On Behalf of Thrombosis Canada
More informationCPT only copyright 2014 American Medical Association. All rights reserved. 12/23/2014 Page 66 of 593
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2015 PQRS OPTIONS FOR INDIVIDUAL MEASURES:
More informationVenous interventions in DVT
Venous interventions in DVT Sriram Narayanan Chief of Vascular and Endovascular Surgery, Tan Tock Seng Hospital A/Prof of Surgery, National University of Singapore ANTI-COAGULATION LMWH Warfarin x 6m Acute
More informationVenous Thrombo-Embolism. John de Vos Consultant Haematologist RSCH
Venous Thrombo-Embolism John de Vos Consultant Haematologist RSCH overview The statistics Pathogenesis Prophylaxis Treatment Agent Duration Incidental VTE Recurrence of VTE IVC filters CVC related thrombosis
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationDVT - initial management NSCCG
Background information Information resources for patients and carers Updates to this care map Synonyms Below knee DVT and bleeding risks Patient with confirmed DVT Scan confirms superficial thrombophlebitis
More informationObjectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
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 informationCANCER ASSOCIATED THROMBOSIS. Pankaj Handa Department of General Medicine Tan Tock Seng Hospital
CANCER ASSOCIATED THROMBOSIS Pankaj Handa Department of General Medicine Tan Tock Seng Hospital My Talk Today 1.Introduction 2. Are All Cancer Patients at Risk of VTE? 3. Should All VTE Patients Be Screened
More informationWith All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis
BRIGHAM AND WOMEN S HOSPITAL With All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis Gregory Piazza, MD, MS Division of Cardiovascular Medicine Brigham and Women s Hospital April
More informationDENOMINATOR: All surgical patients aged 18 years and older undergoing procedures for which VTE prophylaxis is indicated in all patients
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2017 OPTIONS FOR INDIVIDUAL MEASURES:
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 informationGenetic Tests for the Better Outcome of VTE? 서울대학교병원혈액종양내과윤성수
Genetic Tests for the Better Outcome of VTE? 서울대학교병원혈액종양내과윤성수 Thrombophilia A hereditary or acquired disorder predisposing to thrombosis Questions Why should we test? Who should we test For what disorders?
More informationUpdates in Diagnosis & Management of VTE
Updates in Diagnosis & Management of VTE TRACY MINICHIELLO, MD CHIEF, ANTICOAGULATION& THROMBOSIS SERVICE-SAN FRANCISCO VAMC PROFESSOR OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Financial Disclosures-NONE
More informationInterventional Treatment VTE: Radiologic Approach
Interventional Treatment VTE: Radiologic Approach Hae Giu Lee, MD Professor, Dept of Radiology Seoul St. Mary s Hospital The Catholic University of Korea Introduction Incidence High incidence: 250,000-1,000,000/year
More informationTHROMBOSIS RISK FACTOR ASSESSMENT
Name: Procedure: Doctor: Date: THROMBOSIS RISK FACTOR ASSESSMENT CHOOSE ALL THAT APPLY EACH RISK FACTOR REPRESENTS 1 POINT Age 41 60 years Minor Surgery Planned History of Prior Major Surgery (< 1 month)
More informationClinical Policy: Dalteparin (Fragmin) Reference Number: ERX.SPA.207 Effective Date:
Clinical Policy: (Fragmin) Reference Number: ERX.SPA.207 Effective Date: 01.11.17 Last Review Date: 02.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationSlide 1. Slide 2. Slide 3. Outline of This Presentation
Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous
More informationVenous thrombosis in unusual sites
Venous thrombosis in unusual sites Walter Ageno Department of Medicine and Surgery University of Insubria Varese Italy Disclosures Employment Research support Scientific advisory board Consultancy Speakers
More informationPredicting Venous Thromboembolic Complications following Neurosurgical Procedures
1 Predicting Venous Thromboembolic Complications following Neurosurgical Procedures David Dornbos III, Varun Shah, Blake Priddy, Victoria Schunemann, Ciarán Powers Venous Thromboembolic (VTE) Complications
More informationModerators: Malgorzata Lutwin-Kawalec, MD, Dinesh K Choudhry, MD, FRCA. Institution: Nemours/AI DuPont Hospital for Children, Wilmington, DE
PBLD Table # 17 A teenager with Factor V Leiden and pectus excavatum for a Nuss procedure: navigating recommendations for testing, perioperative risk of thrombosis and post-operative pain management. Moderators:
More informationAnticoagulation therapy following endovascular treatment of iliofemoral deep vein thrombosis
Anticoagulation therapy following endovascular treatment of iliofemoral deep vein thrombosis Tim Sebastian, M.D. University Hospital Zurich Clinic for Angiology Disclosure Speaker name: Tim Sebastian I
More informationApproach to Thrombosis
Approach to Thrombosis Theera Ruchutrakool, M.D. Division of Hematology Department of Medicine Siriraj Hospital Faculty of Medicine Mahidol University Approach to Thrombosis Thrombosis: thrombus formation
More informationVenous Thromboembolism (VTE) Prevention
Venous Thromboembolism (VTE) Prevention 7 VTE Risk Assessment: General Patient Population Assess VTE risk at admission, post-op, and transfer See page 2 for VTE risk assessment among Obstetrical (OB) patients
More information10/8/2012. Disclosures. Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines. Goals and Objectives. Outline
Disclosures Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines No relevant conflicts of interest related to the topic presented. Cyndy Brocklebank, PharmD, CDE Chronic Disease Management
More informationAntithrombotic Therapy in Neonates and Children
CHEST Supplement ANTITHROMBOTIC THERAPY AND PREVENTION OF THROMBOSIS, 9TH ED: ACCP GUIDELINES Antithrombotic Therapy in Neonates and Children Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:
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 informationClinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden
Clinical Policy Title: Genetic testing for G1691A polymorphism factor V Leiden Clinical Policy Number: 05.01.03 Effective Date: January 1, 2016 Initial Review Date: July 15, 2015 Most Recent Review Date:
More informationEarly Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement. Marilyn Szekendi, PhD, RN
Early Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement Marilyn Szekendi, PhD, RN ANA 7 th Annual Nursing Quality Conference, February 2013 Research Team Banafsheh Sadeghi,
More informationEpidemiology of venous thrombosis in children with cancer
Review Article 1015 Epidemiology of venous thrombosis in children with cancer Dana Piovesan 1 ; Chantal Attard 1,2 ; Paul Monagle 1,2,3 ; Vera Ignjatovic 1,2 1 Murdoch Childrens Research Institute, Royal
More informationMisunderstandings of Venous thromboembolism prophylaxis
Misunderstandings of Venous thromboembolism prophylaxis Veerendra Chadachan Senior Consultant Dept of General Medicine (Vascular Medicine and Hypertension) Tan Tock Seng Hospital, Singapore Case scenario
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 informationInferior Vena Cava Filters
Inferior Vena Cava Filters and the American Society of Hematology Choosing Wisely Campaign Kevin P. Hubbard, DO, HMDC MACOI Chief - Division of Specialty Medicine Professor and Chair - Section of Internal
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 informationManagement of Cancer Associated Thrombosis (CAT) where data is lacking. Tim Nokes Haematologist, Derriford Hospital, Plymouth
Management of Cancer Associated Thrombosis (CAT) where data is lacking Tim Nokes Haematologist, Derriford Hospital, Plymouth Contents Overview of the statistics and aetiology for Cancer Associated Thrombosis
More informationVTE Management in Surgical Patients: Optimizing Prophylaxis Strategies
VTE Management in Surgical Patients: Optimizing Prophylaxis Strategies VTE in Surgical Patients: Recognizing the Patients at Risk Pathogenesis of thrombosis: Virchow s triad and VTE Risk Hypercoagulability
More informationTrombosi venose superficiali e trombosi venose distali
XXIV Congresso Nazionale SISET Abano 9-12 Novembre 2016 Trombosi venose superficiali e trombosi venose distali Gualtiero Palareti / Benilde Cosmi Università di Bologna Superficial vein thrombosis (SVT):
More informationSociety of Trauma Nurses TraumaCon 03/22/2018
Prophylaxis Against Venous Thromboemblism (VTE) in Pediatric Trauma Society of Trauma Nurses TraumaCon 03/22/2018 Arash Mahajerin, MD, MSCr Hematology, CHOC Children s Specialists Orange, CA Disclosure
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 informationDVT and Pulmonary Embolus. Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre
DVT and Pulmonary Embolus Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre Overview Structure of deep and superficial venous system of upper
More informationMeissner MH, Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, et al. J Vasc Surg. 2012;55:
Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum Meissner MH, Gloviczki P, Comerota AJ,
More informationDr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust
MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital
More informationAnticoagulation for prevention of venous thromboembolism
Anticoagulation for prevention of venous thromboembolism Original article by: Michael Tam Note: updated in June 2009 with the eighth edition (from the seventh) evidence-based clinical practice guidelines
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 informationDeep Vein Thrombosis and Pulmonary Embolism: Patient Information
Deep Vein Thrombosis and Pulmonary Embolism: Patient Information A Deep Vein Thrombosis (DVT) and a Pulmonary Embolism (PE) are both disorders of unwanted blood clotting. Unwanted blood clots can occur
More informationAre guidelines for anticoagulation useful in cancer patients?
Session 3 Striking a Balance Between Bleeding and the Risk of Thrombosis in Cancer Patients Are guidelines for anticoagulation useful in cancer patients? Sebastian Szmit Department of Pulmonary Circulation
More informationFocus: l embolia polmonare Per quanto la terapia anticoagulante orale? Giulia Magnani 27 Gennaio, 2018
Focus: l embolia polmonare Per quanto la terapia anticoagulante orale? Giulia Magnani 27 Gennaio, 2018 NO DISCLOSURE Pulmonary Embolism Venous thromboembolism (VT) is the third most common cause of cardiovascular
More informationNew Guidance in AT10 Clive Kearon, MD, PhD,
New Guidance in AT10 Clive Kearon, MD, PhD, Professor, Department of Medicine, McMaster University; Program Director, McMaster Clinical Investigator Program, McMaster University Head, Clinical Thromboembolism
More informationHow to prevent thrombotic diseases? Sergio Fusco, MD
How to prevent thrombotic diseases? Sergio Fusco, MD Geriatric Division - Department of Internal Medicine Ospedale Dell'Angelo - Venice, Italy CONFLICT OF INTEREST DISCLOSURE I have no potential conflict
More information10 Key Things the Vascular Community Should Know about the DOACs Heather Gornik, MD, RVT, RPVI
10 Key Things the Vascular Community Should Know about the DOACs Heather Gornik, MD, RVT, RPVI Cleveland Clinic Heart and Vascular Institute Heather L. Gornik, MD has the following relationships to disclose:
More informationChallenges in Anticoagulation and Thromboembolism
Challenges in Anticoagulation and Thromboembolism Ethan Cumbler M.D. Assistant Professor of Medicine Hospitalist Medicine Section University of Colorado Denver May 2010 No Conflicts of Interest Objectives
More informationEpidemiology of Thrombosis in Patients with Malignancy. Cancer and Venous Thromboembolism. Chew HK, Arch Int Med, Feb Blom et al, JAMA, Feb 2005
Cancer and Venous Thromboembolism Objectives 1. Epidemiology of thrombosis in patients with malignancy 2. Anticancer agents and thrombosis 3. Current treatment protocols at UHN 4. Prevention of DVT 5.
More informationPerioperative Management of the Anticoagulated Patient
Perioperative Management of the Anticoagulated Patient Citywide Resident Perioperative Medical Consultation Conference 5/5/17 Matthew Eisen, MD Director, Anticoagulation Services MetroHealth Medical Center
More informationUPDATE ON TREATMENT OF ACUTE VENOUS THROMBOSIS
UPDATE ON TREATMENT OF ACUTE VENOUS THROMBOSIS Armando Mansilha MD, PhD, FEBVS 16 th National Congress of the Italian Society of Vascular and Endovascular Surgery Bologna, 2017 Disclosure I have the following
More informationPREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM
PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM International Consensus Statement 2013 Guidelines According to Scientific Evidence Developed under the auspices of the: Cardiovascular Disease Educational
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 informationThe Evidence Base for Treating Acute DVT
The Evidence Base for Treating Acute DVT Mr Chung Sim Lim Consultant Vascular Surgeon and Honorary Lecturer Royal Free London NHS Foundation Trust and University College London NIHR UCLH Biomedical Research
More informationUC SF. Division of General Internal Medicine UNIVERSITY OF CALIFORNIA SAN FRANCISCO, DIVISION OF HOSPITAL MEDICINE
Updates in the Management of Venous Thromboembolism Margaret C. Fang, MD, MPH Associate Professor of Medicine UCSF Division of Hospital Medicine Medical Director, Anticoagulation Clinic Venous Thromboembolism
More information*Corresponding Author:
Audit of venous thromboembolism prophylaxis administered to general surgical patients undergoing elective and emergency operations at National Hospital, Sri Lanka *Migara Seneviratne 1, Asanka Hemachandra
More informationDave Duddleston, MD VP and Medical Director Southern Farm Bureau Life
Dave Duddleston, MD VP and Medical Director Southern Farm Bureau Life Sources of Risk for Venous Diseases Pulmonary embolism (thrombus) Bleeding from anticoagulation Mortality from underlying disease Chronic
More informationPrevention of Venous Thromboembolism
Prevention of Venous Thromboembolism Surgical Care Improvement Project Dale W. Bratzler, DO, MPH President and CEO Dale W. Bratzler, DO, MPH Oklahoma Foundation for Medical Quality QIOSC Medical Director
More informationMeasurement and Improvement of Quality of Cardiovascular Care DR : DEHESTANI
Measurement and Improvement of Quality of Cardiovascular Care DR : DEHESTANI Hospitals For hospitals in the United States, measures of cardiovascular care mandated by the Joint Commission have recently
More informationPrevention and treatment of venous thromboembolic disease
REVIEW Prevention and treatment of venous thromboembolic disease SUSAN McNEILL AND CATHERINE BAGOT Awareness of the risk factors for venous thromboembolic (VTE) disease and timely administration of thromboprophylaxis
More informationCancer and Thrombosis
Cancer and Thrombosis The close relationship between venous thromboembolism and cancer has been known since at least the 19th century by Armand Trousseau. Thrombosis is a major cause of morbidity and mortality
More informationAre there still any valid indications for thrombophilia screening in DVT?
Carotid artery stenosis and risk of stroke Are there still any valid indications for thrombophilia screening in DVT? Armando Mansilha MD, PhD, FEBVS Faculty of Medicine of University of Porto Munich, 2016
More informationVenous thromboembolism after total knee replacement or total hip replacement: what can be learnt from root-cause analysis?
TRAUMA AND ORTHOPAEDIC SURGERY Ann R Coll Surg Engl 2016; 98: 538 542 doi 10.1308/rcsann.2016.0202 Venous thromboembolism after total knee replacement or total hip replacement: what can be learnt from
More informationWhat You Should Know
1 New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know The American Society
More informationThrombosis. Tom DeLoughery, MD FACP. Oregon Health and Sciences University
Thrombosis Tom DeLoughery, MD FACP Oregon Health and Sciences University DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant Amgen, Alexion What I am Talking About New Anticoagulants
More information