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Chapter Seven Venous Disease Coalition

Chapter Seven Venous Disease Coalition. Long-Term Management of VTE. VTE T oolkit. LMWH S/C. 1. Oral Anticoagulation (INR 2.0 - 3.0). Long-Term Treatment of DVT/PE: 2 options. 3 mos.- indefinite. 5-7 d. VTE T oolkit. LMWH S/C. 1. Oral Anticoagulation (INR 2.0 - 3.0).

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Chapter Seven Venous Disease Coalition

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  1. Chapter Seven Venous Disease Coalition Long-Term Management of VTE VTE Toolkit

  2. LMWH S/C 1 Oral Anticoagulation (INR 2.0 - 3.0) Long-Term Treatment of DVT/PE:2 options 3 mos.-indefinite 5-7 d VTE Toolkit

  3. LMWH S/C 1 Oral Anticoagulation (INR 2.0 - 3.0) Long-Term Treatment of DVT/PE:2 options 3 mos.-indefinite 5-7 d 2 ? LMWH S/C pregnancy, uncontrolled adenocarcinoma, high bleeding risk, patient preference VTE Toolkit

  4. Anticoagulation Treatment of VTE Recurrent VTE With anticoagulation, the risk of recurrent VTE is very low. 0 VTE Toolkit Time VTE

  5. Anticoagulation Treatment of VTE If the VTE was provoked (surgery, trauma, pregnancy, acute illness, etc.), the risks of recurrent VTE after a period of anticoagulation is low. Recurrent VTE 0 VTE Toolkit Time VTE

  6. Anticoagulation If the VTE was unprovoked, associated with cancer or some thrombophilias, the risks of recurrent VTE after a period of anticoagulation is higher. Treatment of VTE Recurrent VTE 0 VTE Toolkit Time VTE

  7. D-Dimer to Predict VTE Recurrence Patients with abnormal D-Dimer one month after discontinuation of anticoagulation have a significantly greater incidence of recurrent VTE than patients with a normal D-dimer. Palareti - D-Dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006;355:1780 VTE Toolkit

  8. Ongoing risk factors – cancer, immobility, high risk thrombophilia (APLA, AT deficiency) • Unprovoked initial VTE • Older age • Male gender • Obesity • Residual DVT • Elevated D-dimer 1 month after stopping anticoagulants Predictors of Recurrent VTE VTE Toolkit

  9. 1st Episode: • Transient, reversed risk 3 - 6 mos. • Unprovoked12 mos indefinite* • Ongoing risk (unresolved • cancer, AT deficiency, APLA) indefinite* • Recurrent Episodes: indefinite* Duration of Treatment for VTE • * Periodic reassessment to discuss: • Patient risk factors for bleeding and thrombosis • New knowledge about risk of recurrence • Patient preference VTE Toolkit

  10. Venous Disease Coalition www.vasculardisease.org/venousdiseasecoalition/ VTE Toolkit

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