As indicated by one of the studies presented during the 14th Venous Thromboembolism Forum
Highlights of the presentations and studies:
- New direct-acting oral anticoagulants (DOACs) can work better than classic oral anticoagulants: The RIETE Registry already contains a significant number of patients treated with DOACs. The clinical situations in which DOACs may be better than the standard treatment (heparin or vitamin K antagonist) are becoming apparent.
- Not all low-molecular-weight heparins are the same: it has always been thought that the different low-molecular-weight heparins (enoxaparin, tinzaparin, dalteparin, bemiparin and others) have the same efficacy and safety, probably because they had never been compared in a sufficient number of patients. A study by the RIETE group comparing the frequency of recurrence of thrombosis and severe bleeding in patients with cancer and VTE and shows that some are safer than others.
- Superficial thrombosis is not as innocuous as once thought: There has always been a tendency to think of superficial vein thrombosis as less important. A study by the RIETE group shows that they are usually treated with fewer doses and for less time than deep vein thrombosis. Nonetheless, superficial vein thrombosis may be just as serious as deep vein thrombosis.
- Sintrom should be started early: it has always been argued that vitamin K antagonists (like Sintrom) should be given right after treatment with heparin, without providing evidence for it. A RIETE study shows that many patients who start more than one week after diagnosis have more frequent bleeding, relapse and death.
- Syncope in pulmonary embolism: less than 10% of patients with pulmonary embolism present syncope. A study by the RIETE group examines the different causes of syncope and the relationship between syncope and early mortality.
- Echocardiography in pulmonary embolism: the echocardiogram is a non-invasive diagnostic test that provides prognostic information in pulmonary embolism. A study showing that echocardiography is being performed with increased frequency in pulmonary embolism has given us a better idea of the information obtained with echocardiography.
- Thrombocytopenia in patients with cancer and VTE: a not insignificant percentage of patients with cancer and VTE have low platelet count (thrombocytopenia). This finding is often associated with a serious risk of bleeding, so fewer doses of anticoagulant are given, as a precaution. A study shows how common thrombocytopenia is in these patients, how it is treated and to what extent it influences prognosis.
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