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2020 DEC 5 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on venous thrombosis have been published. According to news [...]

2018 DEC 20 (NewsRx) -- By a News Reporter-Staff News Editor at Women's Health Weekly -- Current study results on Cardiovascular Diseases and Conditions - Venous Thrombosis have been published. [...]

2018 JUL 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators discuss new findings in Cardiovascular Diseases and Conditions - Venous Thrombosis. [...]

2018 JUL 14 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Cardiovascular Diseases and Conditions - Venous Thrombosis is the [...]

Background: The optimal duration of oral anticoagulant therapy in patients with deep venous thrombosis (DVT) of the lower extremities remains uncertain. Objective: To assess whether tailoring the duration of anticoagulation on the basis of the persistence of residual thrombi on ultrasonography reduces the rate of recurrent venous thromboembolism (VTE) compared with the administration of conventional fixed-duration treatment in adults with proximal DVT. Design: Parallel, randomized trial from 1999 to 2006. Trained physicians who assessed outcomes were blinded to patient assignment status, but patients and providers were not. Setting: 9 university or hospital centers in Italy. Patients: 538 consecutive outpatients with a first episode of acute proximal DVT at completion of an uneventful 3-month period of anticoagulation. Intervention: Patients were randomly assigned (stratified by center and secondary vs. unprovoked DVT by using a computer-generated list that was accessible only to a trial nurse) to fixed-duration anticoagulation (no further anticoagulation for secondary thrombosis and an extra 3 months for unprovoked thrombosis) or flexible-duration, ultrasonography-guided anticoagulation (no further anticoagulation in patients with recanalized veins and continued anticoagulation in all other patients for up to 9 months for secondary DVT and up to 21 months for unprovoked thrombosis). For the primary outcome assessment, 530 patients completed the trial. Measurements: The rate of confirmed recurrent VTE during 33 months of follow-up. Results: Overall, 46 (17.2%) of 268 patients allocated to fixed-duration anticoagulation and 32 (11.9%) of 270 patients allocated to flexible-duration anticoagulation developed recurrent VTE (adjusted hazard ratio [HR], 0.64 [95% Cl, 0.39 to 0.99]). For patients with unprovoked DVT, the adjusted HR was 0.61 (Cl, 0.36 to 1.02) and 0.81 (Cl, 0.32 to 2.06) for those with secondary DVT. Major bleeding occurred in 2 (0.7%) patients in the fixed-duration group and 4 (1.5%) patients in the flexible-duration group (P = 0.67). Limitations: The trial lacked a double-blind design. The sample size was not powered to detect differences in bleeding between groups and to detect effectiveness of the intervention in the subgroups of patients with unprovoked and secondary DVT. Patients with previous thromboembolism, permanent risk factors for thrombosis, and thrombophilic abnormalities other than factor V Leiden and prothrombin mutation were excluded. Conclusion: Tailoring the duration of anticoagulation on the basis of ultrasonography findings reduces the rate of recurrent VTE in adults with proximal DVT. Primary Funding Source: None.

Background: The optimal duration of anticoagulation for a first episode of unprovoked venous thromboembolism (VTE) is uncertain. Methods for predicting risk for recurrence may identify low-risk patients who are less likely to benefit from prolonged anticoagulation. Purpose: To synthesize evidence evaluating the value of D-dimer as a predictor of recurrent disease in patients who have stopped anticoagulant therapy after a first unprovoked VTE. Data Sources: The MEDLINE, EMBASE, ClNAHL, and Cochrane databases were searched until March 2008 without language restrictions. The strategy was supplemented with manual review of reference lists and contact with content experts. Study Selection: Randomized, controlled trials or prospective cohort studies that measured D-dimer after anticoagulant therapy in patients who received at least 3 months of anticoagulant treatment of unprovoked VTE. Data Extraction: Two authors independently reviewed articles and extracted data. Data Synthesis: Seven studies, totaling 1888 patients with a first unprovoked VTE, were eligible for analysis. During 4500 personyears of follow up, annual rates of recurrent VTE differed statistically significantly: 8.9% (95% Cl, 5.8% to 11.9%) in patients with positive D-dimer results and 3.5% (Cl, 2.7% to 4.3%) in patients with negative D-dimer results. Limitation: The duration of anticoagulation, timing of D-dimer testing, and D-dimer assay varied across studies. Conclusion: In patients who have completed at least 3 months of anticoagulation for a first episode of unprovoked VTE and after approximately 2 years of follow-up, a negative D-dimer result was associated with a 3.5% annual risk for recurrent disease, whereas a positive D-dimer result was associated with an 8.9% annual risk for recurrence. These rates should inform decisions about the balance of risks and benefits of prolonging anticoagulation.

CASE STUDY 2 Julie is a 28-year-old Caucasian woman who complains of swelling and tightness in her right leg that has been occurring off and on for the past few [...]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2007.01588.x Keywords: exercise; sports activities; venous thrombosis; elderly; exercise intensity Abstract: OBJECTIVES: To study whether exercise is associated with the risk of venous thrombosis in elderly people. DESIGN: Observational study with a median follow-up of 11.6 years. SETTING: The Cardiovascular Health Study in four U.S. communities. PARTICIPANTS: People aged 65 and older without prior venous thrombosis (deep venous thrombosis or pulmonary embolism). MEASUREMENTS: Self-reported exercise was measured two or three times during follow-up and was defined as expending more than 500 kcal/wk on exercise, including walking for exercise. Venous thrombosis cases were verified using medical record review. RESULTS: Of 5,534 participants, 171 developed a first venous thrombosis. Self-reported exercise at baseline was not related to the risk of venous thrombosis after adjustment for sex, age, race, self-reported health, and body mass index (adjusted hazard ratio (HR.sub.adj)=1.16, 95% confidence interval (CI)=0.84-1.61), although with exercise modeled as a time-varying exposure, overall results were in the direction of greater risk of venous thrombosis (HR.sub.adj=1.38, 95% CI=0.99-1.91). For mild-intensity exercise, such as walking, there was a nonsignificant finding in the direction of benefit (HR.sub.adj=0.75, 95% CI=0.49-1.16), but strenuous exercise, such as jogging, was associated with greater risk of venous thrombosis (HR.sub.adj=1.75, 95% CI=1.08-2.83) than no exercise at all. CONCLUSION: In elderly people, strenuous exercise was associated with a higher risk of venous thrombosis than no exercise at all. Future studies are needed to explain this unexpected higher risk. Author Affiliation: (*)Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands (**)Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands ([dagger])Department of Biostatistics, University of Washington, Seattle, Washington ([parallel])Department of Epidemiology, University of Washington, Seattle, Washington (#)Department of Medicine and Health Services, University of Washington, Seattle, Washington ([double dagger])Department of Medicine, University of Vermont, Burlington, Vermont (s.)Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota. Article note: Address correspondence to Susan R. Heckbert, MD, PhD, Cardiovascular Health Research Unit, University of Washington, 1730 Minor Avenue, Suite 1360, Seattle, WA 98101. E-mail: Heckbert@u.washington.edu

2017 JUL 1 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cardiovascular Diseases and Conditions - Venous Thrombosis have [...]

2017 APR 1 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cardiovascular Diseases and Conditions - Venous Thrombosis have [...]

Background: Elevated total homocysteine levels are associated with a higher risk for venous thromboembolism. Whether decreasing homocysteine levels with vitamin therapy reduces the risk for venous thromboembolism is not known. Objective: To determine whether decreasing homocysteine levels alters the risk for symptomatic venous thromboembolism. Design: Secondary analysis of data from the randomized, placebocontrolled Heart Outcomes Prevention Evaluation 2 (HOPE-2) trial. Setting: 145 clinical centers in 13 countries. Participants: 5522 persons 55 years of age or older with known cardiovascular disease or diabetes mellitus and at least 1 other risk factor for vascular disease. Intervention: A daily supplement of 2.5 mg of folic acid, 50 mg of vitamin [B.sub.6], and 1 mg of vitamin [B.sub.12] or matching placebo for 5 years. Measurement: Prospectively diagnosed and confirmed symptomatic deep venous thrombosis or pulmonary embolism. Results: The geometric mean homocysteine level decreased by 2.2 [micro] mol/L in the vitamin therapy group and increased by 0.80/[micro]mol/L in the placebo group. Venous thromboembolism occurred in 88 participants during a mean follow-up of 5 years. The incidence rate of venous thromboembolism was the same in the vitamin therapy group and the placebo group (0.35 per 100 person-years; hazard ratio, 1.01 [95% Cl, 0.66 to 1.53]). Vitamin therapy did not reduce the risk for deep venous thrombosis (hazard ratio, 1.04 [Cl, 0.63 to 1.72]), pulmonary embolism (hazard ratio, 1.14 [Cl, 0.57 to 2.28]), or unprovoked venous thromboembolism (hazard ratio, 1.21 [Cl, 0.66 to 2.23]). Limitations: The proportion of patients with a previous episode of venous thromboembolism at enrollment was not known, and venous thromboembolism events were not centrally adjudicated. Conclusion: Decreasing homocysteine levels with folic acid and vitamins [B.sub.6] and [B.sub.12] did not reduce the risk for symptomatic venous thromboembolism.

Background: Underutilization of anticoagulant prophylaxis may be due to lack of evidence that prophylaxis prevents clinically important outcomes in hospitalized medical patients at risk for venous thromboembolism. Purpose: To assess the effects of anticoagulant prophylaxis in reducing clinically important outcomes in hospitalized medical patients. Data Sources: MEDLINE, EMBASE, and Cochrane databases were searched to September 2006 without language restrictions. Study selection: Randomized trials comparing anticoagulant prophylaxis with no treatment in hospitalized medical patients. Data Extraction: Any symptomatic pulmonary embolism (PE), fatal PE, symptomatic deep venous thrombosis, all-cause mortality, and major bleeding. Pooled relative risks and associated 95% CIs were calculated. For treatment effects that were statistically significant, the authors determined the absolute risk reduction and the number needed to treat for benefit ([NNT.sub.B]) to prevent an outcome. Data Synthesis: 9 studies (n = 19 958) were included. During anticoagulant prophylaxis, patients had significant reductions in any PE (relative risk, 0.43 [CI, 0.26 to 0.71]; absolute risk reduction, 0.29%; [NNT.sub.B], 345) and fatal PE (relative risk, 0.38 [CI, 0.21 to 0.69]; absolute risk reduction, 0.25%; [NNT.sub.B], 400), a nonsignificant reduction in symptomatic deep venous thrombosis (relative risk, 0.47 [CI, 0.22 to 1.00]), and a nonsignificant increase in major bleeding (relative risk, 1.32 [CI, 0.73 to 2.37]). Anticoagulant prophylaxis had no effect on all-cause mortality (relative risk, 0.97 [CI, 0.79 to 1.19]). Limitations: 2 of 9 included studies were not double-blind. Conclusions: Anticoagulant prophylaxis is effective in preventing symptomatic venous thromboembolism during anticoagulant prophylaxis in at-risk hospitalized medical patients. Additional research is needed to determine the risk for venous thromboembolism in these patients after prophylaxis has been stopped.

Background: Venous thromboembolism (VTE) is thought to result from interactions between multiple genetic and environmental risk factors. Objective: To assess the contribution of multiple thrombophilic defects and exogenous risk factors to the absolute risk for VTE. Design: Retrospective family cohort study. Setting: Single university hospital. Participants: 468 relatives of 91 probands with a symptomatic hereditary deficiency of protein S, protein C, or antithrombin. Measurements: All relatives were tested for 10 thrombophilic deficiencies and defects in addition to the index deficiency and were assessed for exogenous risk factors (surgery, trauma, immobilization, use of oral contraceptives, and pregnancy). The authors compared annual incidences and relative risks for VTE in deficient and nondeficient relatives. Results: Annual incidences of VTE in relatives with 0, 1, and 2 or more additional thrombophilic deficiencies or defects were 1.16 (95% CI, 0.60 to 2.03), 1.75 (CI, 1.17 to 2.53), and 2.64 (CI, 1.67 to 3.96) per 100 person-years, respectively, compared with 0.06 (CI, 0.002 to 0.33) per 100 person-years in nondeficient relatives without additional deficiencies or defects. Adjusted relative risks were 16.3 (CI, 2.0 to 131.0), 50.3 (6.5 to 389.7), and 102.8 (12.5 to 843.4). Of deficient relatives, 38% with no additional defect, 57% with I additional defect, and 81% with 2 or more additional defects had VTE at age 65 years compared with 5% of nondeficient relatives (P < 0.001). In deficient relatives with additional deficiencies or defects, exogenous risk factors increased the risk for VTE from 1.20% to 2.51% per year (relative risk, 2.1 [CI, 1.1 to 4.2]). Limitations: This was a retrospective study without the ability to distinguish interactions between specific thrombophilic deficiencies and defects. Conclusion: Additional thrombophilic defects and exogenous risk factors increase the risk for VTE in persons with hereditary deficiencies of protein S, protein C, or antithrombin and provide evidence that multiple genetic and environmental risk factors contribute to VTE.

* Spontaneous superficial venous thrombophlebitis (SVTP) confers a 10-fold risk of developing DVT within 6 months compared with controls. * Absolute risk of DVT following SVTP, however, is just 2.7%, [...]

Background: Venous thrombotic events (VTEs) have been observed in Wegener granulomatosis, but the incidence rate is not known. Objective: To measure the incidence of VTEs in patients with Wegener granulomatosis. Design: Prospective, observational cohort study. Setting: A multicenter, randomized, double-blind, placebo-controlled treatment trial for Wegener granulomatosis. Patients: 180 patients with Wegener granulomatosis enrolled during periods of active disease. Measurements: Venous thrombotic events (deep venous thromboses or pulmonary emboli) were documented and confirmed prospectively. Incidence rates were calculated on the basis of time to first VTE. Results: Thirteen patients had VTEs before enrollment. During 228 person-years of prospective follow-up, 16 VTEs occurred in 167 patients with no history of VTE. Median time from enrollment to VTE for patients with an event was 2.1 months. The incidence of VTE among patients with Wegener granulomatosis was 7.0 per 100 person-years (95% CI, 4.0 to 11.4). Limitations: Although prospectively recorded, screening for VTEs did not occur. Conclusions: The incidence rate of VTEs in Wegener granulomatosis is high when compared with available rates in the general population, patients with lupus, and patients with rheumatoid arthritis. These results have important implications for clinical care of patients with Wegener granulomatosis.