By: Mark Meissner, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Dr. Stephen Mulligan is a leading researcher in chronic lymphocytic leukemia (CLL) based in Australia. He is the founding chair of the CLL Global Consortium and director of hematology programs at the University of Sydney. His research interests include mechanisms of drug resistance in CLL and signaling pathways. Recent breakthroughs in CLL described by Dr. Mulligan include trials showing improved progression-free survival for frontline chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) compared to bendamustine and rituximab (BR). Oral FCR was also found to be safe and effective in elderly CLL patients with overall response rates over 95%.
This document discusses aplastic anemia and infections in patients undergoing stem cell transplantation (SCT) or immunosuppressive therapy (IST) for aplastic anemia in India. It notes that true incidence of aplastic anemia in India is unknown but it is more common in Asia than the West. For patients under 40, SCT from a HLA-matched sibling donor is the treatment of choice. However, late referrals and financial constraints can increase morbidity and mortality during SCT and IST in India due to less effective first-line treatments, recurrent transfusions, and infections. The document provides data on outcomes of various transplantation approaches and immunosuppressive therapies for aplastic anemia at Christian Medical College, Vello
This document discusses inhibitors in congenital hemophilia and their treatment. It begins with an overview of hemophilia A and B, risk factors for inhibitor development like family history and treatment intensity, and mechanisms of inhibitor action. Treatment options discussed include high-dose factor replacement, bypassing agents like activated prothrombin complex concentrate and recombinant factor VIIa, and immune tolerance induction regimens to eradicate inhibitors. Two studies directly comparing aPCC and rFVIIa found they achieved similar rates of hemostasis, though one study found rFVIIa in a single 270 μg/kg dose was more effective than aPCC or multiple 90 μg/kg rFVIIa doses. Prophylaxis with
Ruxolitinib is an oral JAK1 and JAK2 inhibitor that has shown efficacy in reducing splenomegaly and improving symptoms in patients with myelofibrosis based on two phase 3 clinical trials. In COMFORT-I, ruxolitinib resulted in >35% spleen reduction in 42% of patients at week 24 versus 1% on placebo and improved survival. In COMFORT-II, 32% had >35% spleen reduction at week 24 with ruxolitinib versus 0% with best available treatment. While ruxolitinib improved spleen size and symptoms, it did not provide a clear survival benefit in COMFORT-II likely due to
By: Mark J. Garcia MD, MS, FSIR
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Endovenous treatment for varicose veins – the first choice (laser, radiofre...Michał Molski
This document discusses the treatment of varicose veins, specifically endovenous ablation techniques like laser and radiofrequency ablation. It provides a brief history of varicose vein surgery techniques dating back to the early 1900s. More recent developments discussed include techniques like EVLA, RFA, sclerotherapy, steam vein sclerosis, and mechano-chemical ablation. The document also outlines the authors' hospital's experience with various treatment methods and provides their recommendations on when each technique is most appropriate based on factors like patient anatomy, vein diameter and location.
Dr. Stephen Mulligan is a leading researcher in chronic lymphocytic leukemia (CLL) based in Australia. He is the founding chair of the CLL Global Consortium and director of hematology programs at the University of Sydney. His research interests include mechanisms of drug resistance in CLL and signaling pathways. Recent breakthroughs in CLL described by Dr. Mulligan include trials showing improved progression-free survival for frontline chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) compared to bendamustine and rituximab (BR). Oral FCR was also found to be safe and effective in elderly CLL patients with overall response rates over 95%.
This document discusses aplastic anemia and infections in patients undergoing stem cell transplantation (SCT) or immunosuppressive therapy (IST) for aplastic anemia in India. It notes that true incidence of aplastic anemia in India is unknown but it is more common in Asia than the West. For patients under 40, SCT from a HLA-matched sibling donor is the treatment of choice. However, late referrals and financial constraints can increase morbidity and mortality during SCT and IST in India due to less effective first-line treatments, recurrent transfusions, and infections. The document provides data on outcomes of various transplantation approaches and immunosuppressive therapies for aplastic anemia at Christian Medical College, Vello
This document discusses inhibitors in congenital hemophilia and their treatment. It begins with an overview of hemophilia A and B, risk factors for inhibitor development like family history and treatment intensity, and mechanisms of inhibitor action. Treatment options discussed include high-dose factor replacement, bypassing agents like activated prothrombin complex concentrate and recombinant factor VIIa, and immune tolerance induction regimens to eradicate inhibitors. Two studies directly comparing aPCC and rFVIIa found they achieved similar rates of hemostasis, though one study found rFVIIa in a single 270 μg/kg dose was more effective than aPCC or multiple 90 μg/kg rFVIIa doses. Prophylaxis with
Ruxolitinib is an oral JAK1 and JAK2 inhibitor that has shown efficacy in reducing splenomegaly and improving symptoms in patients with myelofibrosis based on two phase 3 clinical trials. In COMFORT-I, ruxolitinib resulted in >35% spleen reduction in 42% of patients at week 24 versus 1% on placebo and improved survival. In COMFORT-II, 32% had >35% spleen reduction at week 24 with ruxolitinib versus 0% with best available treatment. While ruxolitinib improved spleen size and symptoms, it did not provide a clear survival benefit in COMFORT-II likely due to
By: Mark J. Garcia MD, MS, FSIR
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Endovenous treatment for varicose veins – the first choice (laser, radiofre...Michał Molski
This document discusses the treatment of varicose veins, specifically endovenous ablation techniques like laser and radiofrequency ablation. It provides a brief history of varicose vein surgery techniques dating back to the early 1900s. More recent developments discussed include techniques like EVLA, RFA, sclerotherapy, steam vein sclerosis, and mechano-chemical ablation. The document also outlines the authors' hospital's experience with various treatment methods and provides their recommendations on when each technique is most appropriate based on factors like patient anatomy, vein diameter and location.
Who Needs More Testing Beyond Venous Duplex?Vein Global
By: William Marston, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Endovenous Laser Ablation in the Treatment of Recurrent Varicose VeinsMinnesota Vein Center
Aims:
Determine how many patients presented to a single center Vein Specialty Clinic with varicose veins despite prior surgical intervention.
Identify the site and cause of varicose veins in patients with prior surgical intervention.
Assess the role of endovenous laser ablation in the retreatment of varicose veins in patients with prior intervention.
Venous Leg Ulcers: Wound Preparation & Adjuvants to HealingVein Global
By: William Marston, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Radio Frequency Ablation (RFA Treatment ) -Modern Technology for management l...SafeMedTrip
Safemedtrip india's number one company of medical treatment, which provide low cost treatment package for international patient. if you have any problem Please scan and email your medical reports to us at hospitalindia@gmail.com or help@safemedtrip.com or call us at +91-9899993637 and we shall get you a Free, No Obligation Opinion from India's leading Specialist Doctors.
(1) 4% of patients evaluated for leg vein problems had previously undergone vein "stripping" surgery, with recurrent varicose veins present in 71 patients. (2) Recurrence was often due to residual or accessory saphenous veins, perforator veins, or neovascularization. (3) 73% of patients were treated with endovenous laser ablation (EVLA) of saphenous veins, with the majority reporting symptomatic improvement and vein closure at follow-up.
Choosing the Appropriate Truncal Vein Closure DeviceVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
By: Seshadri Raju, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This document discusses varicose vein surgery. It provides an overview of the indications for varicose vein surgery, including pain, swelling, skin changes, ulceration, and appearance. It describes the importance of preoperative evaluation using duplex ultrasound mapping to identify refluxing veins and develop a surgical plan. Finally, it outlines procedural considerations for varicose vein treatment, including the goals of ablating reflux from deep to superficial veins and removing all branch varicosities.
Should C2 Disease Classification Be Broken Down Further? Who Progresses to C4?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
2 Things New! 1290nm Laser & New Saphenous Vein Closure DeviceVein Global
By: Lowell S. Kabnick, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This document discusses thermal ablation as an alternative to surgery for treating great saphenous veins. It notes that randomized trials show thermal ablation is at least non-inferior to surgery for procedural success and clinical outcomes, with improved patient quality of life. The advantages of thermal ablation are outlined as being totally outpatient, avoiding sutures and reducing risks of infection, lymphatic damage, and limitations from anticoagulation. Key steps for performing thermal ablation are described, including patient selection, setting, ultrasound use, catheter placement skills, tumescent anesthesia, and ensuring sufficient heat delivery to the vein wall for durable success. Various technologies for heat delivery are mentioned, and segmental ablation is noted to allow faster patient recovery compared
Future of Non Thermal Ablation: Is the Future of Endovenous AblationVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
1. Despite prior endovenous thermal ablation of saphenous veins, varicose veins were present in 162 out of 197 limbs (82%).
2. Patients presented a median of 36 months after their initial endovenous ablation procedure. The majority were middle-aged females.
3. Recurrence of varicose veins was associated with recanalized saphenous veins in 36% of cases, perforator vein reflux in 31% of cases, and accessory vein reflux in 30% of cases.
Future of RF Ablation: Continuous or Segmental?Vein Global
By: Alan M. Dietzek, MD, RVT, RPVI, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This presentation will be very helpful for interventional radiologist, vascualr sergeons and sonographers. We will discuss the basic concept of varicosities and then step by step their thermal ablation under US guiadance.
Does All Saphenous Reflux Need Ablation?Vein Global
By: Paul M. McNeill, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Varicose Veins were first documented by Sushrutha in India as "Siragranthi". The first surgery for varicose veins was described by Galen in 2nd century AD. Varicose veins are dilated, elongated and tortuous superficial veins caused by venous hypertension due to valvular incompetence or obstruction. Investigations like Doppler ultrasound and air plethysmography help in diagnosis. Management includes conservative measures, sclerotherapy, surgery like vein stripping or ligation of saphenofemoral junction, and newer minimally invasive procedures like radiofrequency ablation and endovenous laser ablation.
This document discusses various treatment options for varicose veins, including conservative management using compression bandages and stockings, medications to improve lymph flow and protect veins, sclerotherapy to harden problematic veins, and surgical procedures such as vein ligation and stripping. More minimally invasive options like endovenous laser ablation and radiofrequency ablation are also covered, which involve inserting a laser or radiofrequency catheter into the vein to cause thermal damage and occlusion. All treatments have potential complications like pain, bruising, bleeding, or deep vein thrombosis.
Aortic Valve Stenosis with low EF : TAVR versus Replacementdrucsamal
1) Patients with low ejection fraction (EF < 50%) and severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVI) have similar mortality at 1 year compared to those with higher EF, despite being higher risk.
2) TAVI is associated with significant improvements in EF, symptoms, and quality of life over 1 year in patients with very low EF (≤30%). However, mortality remains higher compared to those with EF >30%.
3) Both TAVI and surgical aortic valve replacement (SAVR) are associated with improvements in EF at 3 months in propensity matched populations with low EF. Short term outcomes are similar, but TAVI is associated with more pacemakers
Federico Villamil - Argentina - Tuesday 29 - Graft and Patient Outcomesincucai_isodp
The document discusses several challenges and priorities in liver transplantation. It focuses on hepatitis B and C, liver cancer, and non-alcoholic steatohepatitis as common indications for transplantation. Immunosuppression strategies aim to minimize side effects while preventing rejection. Outcomes have improved with new antiviral therapies, though recurrent disease remains a challenge.
Who Needs More Testing Beyond Venous Duplex?Vein Global
By: William Marston, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Endovenous Laser Ablation in the Treatment of Recurrent Varicose VeinsMinnesota Vein Center
Aims:
Determine how many patients presented to a single center Vein Specialty Clinic with varicose veins despite prior surgical intervention.
Identify the site and cause of varicose veins in patients with prior surgical intervention.
Assess the role of endovenous laser ablation in the retreatment of varicose veins in patients with prior intervention.
Venous Leg Ulcers: Wound Preparation & Adjuvants to HealingVein Global
By: William Marston, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Radio Frequency Ablation (RFA Treatment ) -Modern Technology for management l...SafeMedTrip
Safemedtrip india's number one company of medical treatment, which provide low cost treatment package for international patient. if you have any problem Please scan and email your medical reports to us at hospitalindia@gmail.com or help@safemedtrip.com or call us at +91-9899993637 and we shall get you a Free, No Obligation Opinion from India's leading Specialist Doctors.
(1) 4% of patients evaluated for leg vein problems had previously undergone vein "stripping" surgery, with recurrent varicose veins present in 71 patients. (2) Recurrence was often due to residual or accessory saphenous veins, perforator veins, or neovascularization. (3) 73% of patients were treated with endovenous laser ablation (EVLA) of saphenous veins, with the majority reporting symptomatic improvement and vein closure at follow-up.
Choosing the Appropriate Truncal Vein Closure DeviceVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
By: Seshadri Raju, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This document discusses varicose vein surgery. It provides an overview of the indications for varicose vein surgery, including pain, swelling, skin changes, ulceration, and appearance. It describes the importance of preoperative evaluation using duplex ultrasound mapping to identify refluxing veins and develop a surgical plan. Finally, it outlines procedural considerations for varicose vein treatment, including the goals of ablating reflux from deep to superficial veins and removing all branch varicosities.
Should C2 Disease Classification Be Broken Down Further? Who Progresses to C4?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
2 Things New! 1290nm Laser & New Saphenous Vein Closure DeviceVein Global
By: Lowell S. Kabnick, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This document discusses thermal ablation as an alternative to surgery for treating great saphenous veins. It notes that randomized trials show thermal ablation is at least non-inferior to surgery for procedural success and clinical outcomes, with improved patient quality of life. The advantages of thermal ablation are outlined as being totally outpatient, avoiding sutures and reducing risks of infection, lymphatic damage, and limitations from anticoagulation. Key steps for performing thermal ablation are described, including patient selection, setting, ultrasound use, catheter placement skills, tumescent anesthesia, and ensuring sufficient heat delivery to the vein wall for durable success. Various technologies for heat delivery are mentioned, and segmental ablation is noted to allow faster patient recovery compared
Future of Non Thermal Ablation: Is the Future of Endovenous AblationVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
1. Despite prior endovenous thermal ablation of saphenous veins, varicose veins were present in 162 out of 197 limbs (82%).
2. Patients presented a median of 36 months after their initial endovenous ablation procedure. The majority were middle-aged females.
3. Recurrence of varicose veins was associated with recanalized saphenous veins in 36% of cases, perforator vein reflux in 31% of cases, and accessory vein reflux in 30% of cases.
Future of RF Ablation: Continuous or Segmental?Vein Global
By: Alan M. Dietzek, MD, RVT, RPVI, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This presentation will be very helpful for interventional radiologist, vascualr sergeons and sonographers. We will discuss the basic concept of varicosities and then step by step their thermal ablation under US guiadance.
Does All Saphenous Reflux Need Ablation?Vein Global
By: Paul M. McNeill, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Varicose Veins were first documented by Sushrutha in India as "Siragranthi". The first surgery for varicose veins was described by Galen in 2nd century AD. Varicose veins are dilated, elongated and tortuous superficial veins caused by venous hypertension due to valvular incompetence or obstruction. Investigations like Doppler ultrasound and air plethysmography help in diagnosis. Management includes conservative measures, sclerotherapy, surgery like vein stripping or ligation of saphenofemoral junction, and newer minimally invasive procedures like radiofrequency ablation and endovenous laser ablation.
This document discusses various treatment options for varicose veins, including conservative management using compression bandages and stockings, medications to improve lymph flow and protect veins, sclerotherapy to harden problematic veins, and surgical procedures such as vein ligation and stripping. More minimally invasive options like endovenous laser ablation and radiofrequency ablation are also covered, which involve inserting a laser or radiofrequency catheter into the vein to cause thermal damage and occlusion. All treatments have potential complications like pain, bruising, bleeding, or deep vein thrombosis.
Aortic Valve Stenosis with low EF : TAVR versus Replacementdrucsamal
1) Patients with low ejection fraction (EF < 50%) and severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVI) have similar mortality at 1 year compared to those with higher EF, despite being higher risk.
2) TAVI is associated with significant improvements in EF, symptoms, and quality of life over 1 year in patients with very low EF (≤30%). However, mortality remains higher compared to those with EF >30%.
3) Both TAVI and surgical aortic valve replacement (SAVR) are associated with improvements in EF at 3 months in propensity matched populations with low EF. Short term outcomes are similar, but TAVI is associated with more pacemakers
Federico Villamil - Argentina - Tuesday 29 - Graft and Patient Outcomesincucai_isodp
The document discusses several challenges and priorities in liver transplantation. It focuses on hepatitis B and C, liver cancer, and non-alcoholic steatohepatitis as common indications for transplantation. Immunosuppression strategies aim to minimize side effects while preventing rejection. Outcomes have improved with new antiviral therapies, though recurrent disease remains a challenge.
VTE and Cancer Healthcare Professional Educationvtesimplified
Cancer patients are at increased risk of developing blood clots (venous thromboembolism or VTE) due to factors such as tumour infiltration of blood vessels, immobility, and cancer treatments. VTE is a leading cause of death in cancer patients and the risk is highest in the first months after diagnosis. Guidelines recommend thromboprophylaxis for hospitalized cancer patients without bleeding risk, but evidence for routine outpatient prophylaxis is limited to certain high risk groups. Risk assessment tools can help identify those at highest risk who may benefit most from prophylaxis.
1) Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects over 900,000 Americans each year and can be fatal. The risk of recurrence of VTE is 17-30% over time without continued anticoagulation treatment.
2) The risk of recurrent VTE depends on factors like whether the initial VTE was provoked by surgery or other transient risk factors, whether the patient has active cancer, and whether it is a first or subsequent episode of VTE. Hereditary thrombophilias alone do not strongly determine recurrence risk.
3) Treatment options for VTE include anticoagulants like warfar
Deep vein thrombosis and pulmonary embolism are serious conditions that can be fatal if not properly treated. This document discusses the etiology, diagnosis, treatment and prevention of venous thromboembolism. It notes that venous thromboembolism affects millions of people worldwide each year and carries high economic costs. Diagnosis involves assessment of clinical probability followed by D-dimer and ultrasound testing. Treatment involves anticoagulation medications like low molecular weight heparins or novel oral anticoagulants. Catheter-directed thrombolysis may be considered in some cases to help restore blood flow.
1) Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects around 900,000 people per year in the United States, causes around 100,000 deaths per year, and is a leading cause of preventable hospital death.
2) The document discusses guidelines for diagnosing and treating VTE, including which anticoagulants to use, how long to treat, considerations for cancer patients, and whether to use thrombolytics or inferior vena cava filters.
3) It also addresses frequently asked clinical questions like whether to treat incidental or distal PEs, the risks of recurrence for provoked versus unprov
- A study analyzed data from the DIG trial to examine the effect of digoxin on 30-day hospital admissions in older adults with heart failure.
- The study found that digoxin reduced the absolute risk of all-cause hospital admission within 30 days by 2.7% and the relative risk by 34% compared to placebo. Digoxin also reduced the risk of cardiovascular hospital admissions at 30 days by 47%.
- The beneficial effect of digoxin on reducing 30-day hospital admissions persisted out to 60 and 90 days with no signs of harm, suggesting digoxin provides early benefits without increasing later risks.
Thromboprophylaxis in orthopedic surgeryNida fatima
This document provides an overview of thromboprophylaxis in orthopedic surgery. It discusses venous thromboembolism (VTE) risks following orthopedic surgeries like hip or knee replacement. The document reviews general VTE risk factors and guidelines for thromboprophylaxis. It compares the effectiveness of different pharmacological and mechanical prophylaxis options, including low molecular weight heparins, warfarin, factor Xa inhibitors like rivaroxaban and apixaban, and fondaparinux. The document summarizes dosing, mechanisms of action, and adverse effects of various medications used for VTE prevention in orthopedic surgery patients.
TAVI 2013: Revisión y perspectivas futurasCardioTeca
This document summarizes a presentation on transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis. It discusses the prevalence of aortic stenosis increasing with age. TAVI is presented as the first choice treatment for patients who are at high surgical risk or deemed inoperable due to comorbidities. The document reviews the various TAVI devices available, the pre-procedure patient evaluation, and the step-by-step TAVI procedure. Results from the PARTNER trial are summarized, showing reduced mortality and repeat hospitalizations with TAVI compared to standard therapy in inoperable patients, as well as similar outcomes to surgical aortic valve replacement in high-risk patients. Quality of life is also improved
This document summarizes evidence on the use of radiation therapy in the management of ductal carcinoma in situ (DCIS) of the breast. It reviews data from four randomized controlled trials showing that the addition of radiation therapy after breast-conserving surgery significantly reduces rates of local recurrence compared to surgery alone, including reductions in both invasive and non-invasive recurrences. It also discusses several non-randomized studies exploring selective use of radiation therapy in patients with favorable tumor characteristics, and ongoing questions about the need for radiation therapy in all patients with DCIS.
1) There is a considerable risk of recurrent venous thromboembolism (VTE) after stopping anticoagulation treatment, ranging from 3-15% per year depending on risk factors.
2) Cancer patients have a high risk of both recurrent VTE and bleeding during anticoagulation treatment.
3) Patients with a provoked VTE have a low recurrence risk of around 3% per year, while those with an unprovoked VTE have a risk up to 15% per year.
4) The risk of recurrence increases as soon as anticoagulation is stopped regardless of the previous duration of treatment.
Venous Thromboembolism (VTE): Recent Advances in Reducing the Disease BurdenNBCA
- Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality worldwide. It is estimated that there are 900,000 cases of VTE per year in the US.
- Recent clinical trials have found that the direct oral anticoagulants rivaroxaban, apixaban, edoxaban and dabigatran are non-inferior to standard therapy for treating VTE and reduce the risk of recurrence, while having a similar or lower risk of bleeding.
- The EINSTEIN DVT and EINSTEIN PE trials found that rivaroxaban was non-infer
This document discusses endovascular thrombolytic therapy for acute deep vein thrombosis (DVT). It provides background on the quality of life issues for DVT patients, including long term complications like post-thrombotic syndrome (PTS). It reviews evidence that immediate clot removal may help prevent PTS by preserving venous valves and function. The document outlines the ATTRACT trial, a large multicenter randomized controlled trial testing whether catheter-directed thrombolysis (CDT) plus standard therapy is more effective than standard therapy alone for reducing PTS in patients with acute proximal DVT. It lists the primary and secondary outcomes that will be assessed to determine if CDT is safer, improves quality of life, and is cost-
This document discusses transcatheter aortic valve implantation (TAVI) for treating severe aortic stenosis. It summarizes several key trials that demonstrated the safety and effectiveness of TAVI compared to surgical aortic valve replacement. The PARTNER trials showed TAVI to be non-inferior to surgery in reducing mortality, while being associated with lower risks of bleeding, stroke, and repeat hospitalization. Subsequent trials like the CoreValve US Pivotal Trial and CHOICE trial reinforced TAVI as a standard treatment for high-risk surgical patients with aortic stenosis.
Clinical Impact of New Data From AASLD 2015hivlifeinfo
In this downloadable slideset, David R. Nelson, MD, and Norah Terrault, MD, MPH, review key HCV studies presented at the 2015 Annual Meeting of the European Association for the Study of the Liver.
Format: Microsoft PowerPoint (.ppt)
File size: 2.19 MB
Date posted: 12/2/2015
4 dan atar - anticoagulation af pci - what do trials saywebevo5
Professor Dan Atar presented on anticoagulation for atrial fibrillation and percutaneous coronary intervention based on recent trial results. The WOEST trial found that dual therapy with a vitamin K antagonist (VKA) and clopidogrel reduced bleeding compared to triple therapy with a VKA, aspirin, and clopidogrel, with a potential mortality benefit. The PIONEER AF-PCI trials found that rivaroxaban dual or triple therapy was associated with significantly less bleeding than VKA triple therapy, with comparable efficacy. The RE-LY-DUAL PCI study found dabigatran dual therapy significantly reduced bleeding compared to warfarin triple therapy. Guidelines recommend balancing the risks of bleeding from
This study updated the Vienna Prediction Model for predicting recurrent venous thromboembolism (VTE) risk by developing a "Dynamic Vienna Prediction Model" that uses serial D-dimer measurements over time. The study found that D-dimer levels did not substantially change after anticoagulation treatment. It also found that the effects of risk factors like sex and initial VTE location on recurrence risk may weaken over time. The new model integrates patient characteristics and serial D-dimer data to assess recurrence risk not just at 3 weeks but also at later time points, allowing for more flexible risk counseling and anticoagulation decisions.
Fundación EPIC _ Is valve durability an issue?Fundacion EPIC
Presentación de la ponencia "Is valve durability an issue?" por el Dr Prendergast en los Diálogos EPIC_Retos Clínicos en Válvulas Transcatéter/ Clinical Challenges in TAVR today, el 10 de Mayo de 2018 en Barcelona (España)
Polidocanol Endovenous Microfoam: Where Are We?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Review of Randomized Controlled Trials Comparing Endovenous Thermal and Chemi...Vein Global
By: Edward G. Mackay, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
When is MR Venography Useful? What makes it so Operator Dependent?Vein Global
By: Constantino S.Peña
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
By: Steve Elias MD FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Thigh, Calf & Ankle Perforators: Are They Different?Vein Global
By: Nicos Labropoulos, PhD, RVT
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The Important Nerves During Venous AblationVein Global
By: John Mauriello, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Outcomes of Venous Interventions in C5-6 DiseaseVein Global
By: Mark H. Meissner, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Diagnosis of Llio-caval Venous Obstruction: Causes of Venous ObstructionVein Global
By: William Marston, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Detecting Deep Venous Disease with Duplex UltrasoundVein Global
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
How do Laser Wavelengths & Fibers Differ Clinically?Vein Global
By: Thomas M. Proebstle, M.D.
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Deep Vein Pathophysiology: Reflux & ObstructionVein Global
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2. Mark H. Meissner, MD
Professor of Surgery
University of Washington School of Medicine
Seattle, WA
VTE & Duration of Anticoagulation
3. DVT – Duration of Treatment
ACCP Guidelines, Chest 2008
• Duration of anticoagulation guided by randomized trials
• RCT endpoints
• Recurrent VTE
• Bleeding
• 2008 recommendations
• Reversible factors – VKA for 3 months (1A)
• Unprovoked DVT
First episode – VKA for 3 months (1A) with re-evaluation for long-
term treatment (1C)
Second episode – Long-term treatment (1A)
Isolated calf thrombosis – VKA for 3 months (2B)
• Cancer – LMWH for 3 – 6 months (1A) , subsequent
LMWH or VKA indefinitely or until cancer resolved (1C)
4. But Are The Guidelines Always Helpful?
What does “assess for long-term” anticoagulation
REALLY mean?
5. Do You Test For Thrombophilia?
Undefined - 28%
Factor V - 20%
Factor VIII - 16%
Hyperhomocysteinemia
10%
APLA - 10%
Prothrombin 20210A
6%
Protein C - 5%
Protein S - 3%
AT III - 1%
Disfibrinogenemia - 1%
6. Risk & Incidence of a First DVT
Bauer KA, Ann Intern Med 2001
Variable Relative Risk Annual Incidence
Normal 1 0.008
Hyperhomocysteinemia 2.5 0.02
Homozygous MTHFR 1 0.008
Prothrombin G20210A 2.8 0.02
Oral Contraceptive Use 4 0.03
Heterozygous FV Leiden 3 - 7 0.06
Homozygous FV Leiden 80 0.5 - 1
Factor VIII > 150% 4.8 0.04
AT, Protein C Deficiency 7.3 – 15
Protein S Deficiency 2
Blood Group A 1.9 – 3.2
7. Recurrent Idiopathic VTE
Kearon et al, New Engl J Med 1999
Recurrent VTE (p < 0.001)
Warfarin group - 1.3% / patient-year
Placebo - 27.4% / patient-year
Defect Recurrence
(n = 17)
No Recurrence
(n = 66)
p
V Leiden 19% 29% ns
G20210A 6% 3% ns
APL Antibody 25% 3% 0.03
Warfarin X 3 mo
Warfarin X 24 mo (n = 79)
Placebo X 24 mo (n = 83)
History a better predictor than genetic tests
8. Thrombophilia and Recurrent VTE
Simpson EL, Health Technology Assessment 2009
Thrombophilia
Incidence in VTE
(%)
Recurrence
(RR)
Change in
Management
FVL Heterozygous 10 – 50% 1.0 No
PTG20210A Heterozygous 5 – 18% 1.48 No
FVL / 20210A Heterozygous - 5.4 Yes
Antiphospholipid Antibodies 5.4% 6.8 Yes
Hyperhomocysteinemia 5.7 - 35% 2.7 Yes
Antithrombin 0.5 – 3% Yes
Protein C Deficiency 3 – 5% 1.44 No
Protein S Deficiency 1 – 5% 1.44 No
Most common defects not associated with significant recurrence
Attributable risk – 9% (1 in 10 recurrent VTE events)
Absence of defect ≠ Absence of thrombophilia
9. The Thrombophilic Phenotype
Venous thromboembolism
Onset at young age (< age 50)
Recurrent thrombotic events
Family history of VTE
DVT at unusual anatomic sites
Unprovoked idiopathic DVT
Recurrent 2nd and 3rd trimester pregnancy loss
Complications of pregnancy
Preeclampsia
Abruptio placenta
Intrauterine growth retardation
?? Aseptic necrosis of femoral head
10. Is Ultrasound Useful?
Prandoni et al, Ann Intern Med 2009
• Ultrasound at 3, 9, 15, and 21 months
• Compression of common femoral & popliteal veins
• Recanalization – Single diameter < 2mm or serial diameters < 3mm
• Recurrent VTE (33 mo) in 17.8% (Fixed AC) versus 12.3% (Flexible AC)
• Secondary DVT - HR 0.81 (95% CI 0.32 – 2.06)
• Idiopathic DVT – HR 0.61 (95% CI 0.36 – 1.02)
• No significant difference in major bleeding
• 538 patients randomized
• Fixed duration AC
Secondary DVT – 3 mo
Idiopathic DVT – 6 mo
• Flexible duration AC
Secondary – Up to 12 mo
Idiopathic – Up to 24 months
11. What Did These Trials Measure?
Author Criteria for Recanalization
Prandoni 2009 Single D2 < 2 mm, Serial D2 < 3 mm
Siragusa 2008 D2 < 40% D1
THROMBUS
THROMBUS
THROMBUS
THROMBUS
UNCOMPRESSED
PROBE COMPRESSION
D1
D2
Point measurements in common femoral & popliteal veins
Residual Thrombus No Residual Thrombus
12. Residual Venous Obstruction (RVO) & D-Dimer
Cosmi et al; Thromb Haemost 2005
• 400 patient with first idiopathic DVT
• 6 months anticoagulation recommended
• Compression U/S at AC withdrawal
• D-Dimer (nl < 500) 30 days after AC withdrawal
Recurrence Hazard Ratio p
(-) D-dimer; (-) RVO 5.7% 1 (reference)
(-) D-dimer; (+) RVO 10.4% 1.66 (0.6 - 4.8) .35
(+) D-dimer; (-) RVO 22.9% 4.3 (1.56 - 11.88) .005
(+) D-dimer; (+) RVO 25.9% 4.76 (1.78 - 12.8) .002
RVO does not independently predict recurrence
13. D-Dimer & Anticoagulant Duration
Palareti et al; N Engl J Med 2006
• 608 pts with first idiopathic DVT
• D-dimer 30 days after anticoagulants
discontinued
• Normal - 385 (63%)
• Abnl - 223 (47%)
No anticoagulation - 120
Anticoagulation - 103
• Mean f/u - 1.4 years
• Recurrent VTE + Bleeding
• Nl D-dimer - 6.2%
• Abnl D-dimer (anticoag) - 2.9%
• Abnl D-dimer (no anticoag) - 15.0%
14. Conclusions - Duration of Anticoagulation
Currently determined by trials balancing recurrent VTE and bleeding
Unprovoked calf vein thrombosis – 3 months
Reversible risk factors – 3 months
Unprovoked DVT
1st episode – Assess risk versus benefits after 3 months
2nd episode – Long-term treatment
Selective thrombophilia testing may be warranted but …
Absence of identified defect ≠ absence of thrombophilia
Limited positive predictive value for recurrence
History is the most important determinant of prognosis
Persistent thrombus on U/S (at least in U.S) is not validated
Promising role for D-dimer