Secondary Prevention of Systemic Arterial and Recurrent Venous Thromboembolic Events, Through Extended Time Anticoagulation with Apixaban, in an Elderly Patient with Multiple Comorbidities, Clinical Case
DOI:
https://doi.org/10.3823/2035Keywords:
Thromboprophylaxis, deep vein thrombosis, vitamin K antagonist (acenocumarol), novel/ target-specific/ direct oral anticoagulant (NOACs, TSOAs, DOACs), stroke sequelaeAbstract
The clinical case illustrates the daily practice with an individualized, adjusted thromboprophylactic dose of apixaban (2.5 mg twice-daily, follow-up for 20 months), mandatory indicated as a continuous therapy for secondary prevention of systemic arterial embolism and recurrent venous thromboembolic events, in an elderly obese patient, associating multiple pathological conditions (chronically anticoagulated for non valvular atrial fibrillation and stroke sequelae, multiple metabolic comorbidities such as type 2 diabetes mellitus , hyperuricemia, moderate renal insufficiency, hyperuricemia), who submitted a severe “unprovoked†phlegmasia alba dolens in the sound (left) lower limb, a decade after a (most possible) iatrogenic deep vein thrombosis at the paralyzed (right) limb.
Thromboprophylaxis for an extended time, without any medical complications (neither systemic or venous thrombotic events, nor hemorrhagic ones) confirmed the product`s efficacy and safety profile. Physiopathological considerations and essential pharmacological considerations were discussed, focused on the individualized safe therapeutic approach.
Â
Â
References
Oldgren J, Healey JS, Ezekowitz M, et al. Variations in etiology and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: The RE-LY AF Registry. Circulation 2014; 15;129(15):1568-76
Gómez-Outes A, Terleira-Fernández AI, Lecumberri R, Suárez-Gea ML, Vargas-Castrillón E., Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. Thromb Res. 2014; 134(4):774-82
Jenkins JS, Michael P, Deep Venous Thrombosis: An Interventionalist's Approach, Ochsner J. 2014; 14(4): 633–640
Clayton TC, Gaskin M, Meade TW. Recent respiratory infection and risk of venous thromboembolism: case–control study through a general practice database. Int J Epidemiol. 2011; 40(3):819-27
Kearon C, Akl E, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al., Antithrombotic therapy for VTE Disease: Chest Guideline and Expert Panel Report, Chest 2016; 149(2):315-352
Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R, McBane RD, Moll S, Ansell J. Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis 2016; 41(1):32-67
van der Hulle T, Kooiman J, den Exter PL, Dekkers OM, Klok FA, Huisman MV, Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis, J Thromb Haemost. 2014; 12(3):320-8
Gómez-Outes A, Terleira-Fernández AI, Lecumberri R, Suárez-Gea ML, Vargas-Castrillón E., Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. Thromb Res. 2014; 134(4):774-82
Rollins BM, Silva MA, Donovan JL, Kanaan AO., Evaluation of Oral Anticoagulants for the Extended Treatment of Venous Thromboembolism Using a Mixed-Treatment Comparison, Meta-Analytic Approach. Clin Ther 2014; 1;36(10): 1454-64
Mantha S, Ansell J., Indirect comparison of dabigatran, rivaroxaban, apixaban and edoxaban for the treatment of acute venous thromboembolism., J Thromb Thrombolysis 2015; 39, 2, 155-165
Sardar P, Chatterjee S, Mukherjee D., Efficacy and safety of new oral anticoagulants for extended treatment of venous thromboembolism: systematic review and meta-analyses of randomized controlled trials. Drugs. 2013; 73(11): 1171-82
van Es N, Coppens M, Schulman S, Middeldorp S, Büller HR. Direct oral anticoagulants compared with vitamin K antagonists for acute symptomatic venous thromboembolism: evidence from phase 3 trials. Blood 2014; 18;124(12):1968-75
VÃlchez JA, Gallego P, Lip G, Safety of new oral anticoagulant drugs: a perspective , Ther Adv Drug Saf. 2014; 5(1):8–20
Agnelli G, Becattini C, Franco L., New oral anticoagulants for the treatment of venous thromboembolism. Best Pract Res Clin Haematol. 2013; 26(2):151-61
Trkulja V., Safety of apixaban for venous thromboembolism prophylaxis: the evidence to date. Drug Healthc Patient Saf. 2016; 18; 8:25-38
Toth PP, Considerations for long-term anticoagulant therapy in patients with venous thromboembolism in the novel oral anticoagulant era. Vasc Health Risk Manag. 2016; 10;12:23-34
HAS-BLED Score for Major Bleeding Risk, Available from: http://www.mdcalc.com/has-bled-score-for-major-bleeding-risk/
Hijazi Z, Oldgren J, Lindbäck J, Alexander J, Connolly S, Eikelboom J, et al, The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study, Lancet, 387, No. 10035, p2302–2311, June 2016 DOI: http://dx.doi.org/10.1016/S0140-6736(16)00741-8
Liew A, Eikelboom JW, O'Donnell M, Hart RG., Assessment of anticoagulation intensity and management of bleeding with old and new oral anticoagulants. Can J Cardiol. 2013; 29(7 Suppl): S34-44
European Medicines Agency (latest renewal Jan. 2016) Available from: <http://www.ema.europa.eu>
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
Â
Â