In this uncontrolled trial of 1262 patients on oral anticoagulants undergoing a variety of procedures, patients were assigned to a standard protocol for peri-procedural bridging, and followed for 30 days to assess bleeding or thromboembolism. Oral anticoagulants were stopped 5 days before the procedure, and LMWH was started 3-4 days before the procedure (and stopped 12 hours before; the dose was 70U/kg BID in high thromboembolic risk, and 57 U/kg Qday in low-intermediate risk). LMWH was re-started 1 day post-procedure for 6 days or until therapeutic INR. Oral anticoagulants were also resumed 1 day post-procedure at 50% higher dose for 2 days. Thromboembolism occurred in 0.4% (none of which had appropriate LMWH administered), and major bleeding occurred in 1.2% (none of which were fatal). This protocol seems safe and effective for peri-procedural bridging (abstract).
I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how […]
As you can see, no glamour shots for this month’s post. I knew it would come at some point, and my first hospitalization related to my CLL came in a big way in mid-July. Given my interest in global health, it was only fitting that I managed to get sick while out of the […]
This large multicenter trial randomized patients with acute VTE to apixaban (10mg BID for 1 week, followed by 5mg BID for 6 months) versus conventional therapy (lovenox-warfarin). The primary outcome was similar between groups (symptomatic VTE or death related to VTE), but major and minor bleeding occurred significantly less often with apixaban. Apixaban is a […]