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Results: 1.Progression of thrombus length and volume (40% vs. 28%; P<.001) 2.Reduced pain with compression and ambulation (P<.001) 3.Reduced edema (P<.001)

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Presentation on theme: "Results: 1.Progression of thrombus length and volume (40% vs. 28%; P<.001) 2.Reduced pain with compression and ambulation (P<.001) 3.Reduced edema (P<.001)"— Presentation transcript:

1 Results: 1.Progression of thrombus length and volume (40% vs. 28%; P<.001) 2.Reduced pain with compression and ambulation (P<.001) 3.Reduced edema (P<.001) 4.No new PE on V/Q scan Results: 1.Progression of thrombus length and volume (40% vs. 28%; P<.001) 2.Reduced pain with compression and ambulation (P<.001) 3.Reduced edema (P<.001) 4.No new PE on V/Q scan Deep Vein Thrombosis Initial Treatment: Compression & Ambulation 1.Blattler W., et al Int’l Angiol. 2003; 32: 861-9 2.Partsch H. et al J Vasc Surg 2000; 32: 861-9 1.Blattler W., et al Int’l Angiol. 2003; 32: 861-9 2.Partsch H. et al J Vasc Surg 2000; 32: 861-9

2 Acute DVT Duration of Anticoagulation Studies have shown… …the longer the better!

3 Anticoagulation for Acute DVT Duration of Warfarin: Randomized Trial Kearon C et al NEJM 1999;340;901. Kearon C et al NEJM 1999;340;901. Recurrent VTE 3 Mos 24.1 >1 Year 1.3 P-value <0.001 RRR 95% Endpoint (non-fatal)(non-fatal) Percent per Patient Year Major Bleed 0 0 3.8 - - 0.09 Study Stopped @ Interim Analysis

4 Long-Term Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism Ridker PM, Goldhaber SZ, Danielsen E, et al and the PREVENT Investigators New England Journal of Medicine 2003; 348:15 Long-Term Low-Intensity Warfarin Therapy for the Prevention of Recurrent Venous Thromboembolism Ridker PM, Goldhaber SZ, Danielsen E, et al and the PREVENT Investigators New England Journal of Medicine 2003; 348:15 Acute DVT Duration of Anticoagulation

5 Long-Term Low-Intensity Anticoagulation Major Study Endpoints (@ 2.1 yrs. mean) Ridker PM, et al NEJM 2003; 348:15 Ridker PM, et al NEJM 2003; 348:15 Recurrent DVT Major Bleed Death Composite Recurrent DVT Major Bleed Death Composite <0.001 0.25 0.26 0.01 <0.001 0.25 0.26 0.01 62% -253% 50% 48% 62% -253% 50% 48% RRR P-value 14.6% 0.8% 0.32% 16.2% 14.6% 0.8% 0.32% 16.2% Placebo (n = 253) Placebo (n = 253) 5.5% 1.9% 0.16% 8.6% 5.5% 1.9% 0.16% 8.6% Warfarin (n = 255) Warfarin (n = 255)

6 Ridker PM, et al NEJM 2003; 348:15 Long-Term Low-Intensity Anticoagulation

7 Ridker PM, et al NEJM 2003; 348:15 Long-Term Low-Intensity Anticoagulation

8 Acute DVT: Anticoagulation 738 patients Rx’ed ≥ 3 mos for VTE Randomized –Warfarin INR 2.0 – 3.0 –Warfarin INR 1.5 – 1.8 Followed average 2.4 years Endpoints: Recurrent VTE Bleeding 738 patients Rx’ed ≥ 3 mos for VTE Randomized –Warfarin INR 2.0 – 3.0 –Warfarin INR 1.5 – 1.8 Followed average 2.4 years Endpoints: Recurrent VTE Bleeding Low-Intensity vs. Conventional Kearon, et al NEJM 2003;349:631-9 Kearon, et al NEJM 2003;349:631-9

9 Acute DVT: Anticoagulation Low-Intensity vs. Conventional 0.09 2.1 0.9 1.9 Death 0.26 1.3 3.7 4.9 Any bleed 0.76 1.2 0.9 1.1 Major bleed 0.03 2.8 0.7 1.9 Recurrent VTE P-valve Hazard Ratio Conven Low No. per 100 person years Kearon, et al NEJM 2003;349:631-9 Kearon, et al NEJM 2003;349:631-9

10 Acute DVT: Anticoagulation Low-Intensity vs. Conventional Ridker PM, et al NEJM 2003; 348:15 Risk Reduction of Recurrence Low Intensity Conventional 64% 95% No difference in bleeding complications Kearon, et al NEJM 2003;349:631-9 Kearon, et al NEJM 2003;349:631-9


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