Sekundärprophylaxe der venösen Thromboembolie

W. Blättler; H. E. Gerlach

doi:10.1055/s-0037-1621479

Phlebologie, Table of Contents

Phlebologie 2005; 34(03): 146-154
DOI: 10.1055/s-0037-1621479

Originalarbeit

Schattauer GmbH

Sekundärprophylaxe der venösen Thromboembolie

Secondary prophylaxis of deep vein thrombosisLa prévention secondaire de la thrombose veineuse

W. Blättler

¹Zentrum für Gefäßkrankheiten Angio Bellaria, Zürich, Schweiz

,

H. E. Gerlach

²Praxis für Phlebologie, Mannheim, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Die Behandlung der akuten venösen Thromboembolie ist weitgehend standardisiert, effektiv und sicher. Die Prävention von Rezidiven ist dies nicht. Die Antikoagulation verhindert Rezidive zuverlässig, ist aber mit erheblichen Blutungsgefahren vergesellschaftet. Nach Absetzen der Antikoagulation drohen Rezidive in 0 bis >20% der Fälle. Ein relativ niedriges Risiko besteht, wenn es sich um eine sekundäre Thrombose handelt, die auslösende Ursache nicht weiter besteht, die Therapie schnell und korrekt erfolgte, keine Thrombusreste mehr vorhanden sind und die D-Dimer- Konzentration im Referenzbereich liegt. Ein hohes Rezidivrisiko liegt vor, wenn die tiefe Venenthrombose idiopathisch war oder in Zusammenhang stand mit einem Krebsleiden oder einem Antikörper im Gerinnungssystem. Eine etwas geringere Rolle spielt das eventuelle Vorhandensein einer molekularen Thrombophilie. Strategien zur Vermeidung von Rezidiven werden aufgezeigt.

Summary

The management of acute deep vein thrombosis is standardized, effective and safe. The prevention of recurrences is much less established. Anticoagulant treatment reliably prevents recurrence but is associated with a considerable risk of bleeding. After discontinuation of anticoagulant therapy recurrences occur with a frequency between 0 and >20%. A relatively modest risk is observed if the deep vein thrombosis was secondary to a transient condition, if therapy was started rapidly and correctly, if the thrombi had completely disappeared, and the D-dimer concentration is within the reference range. A relatively high risk of recurrence is associated with an idiopathic origin of the deep vein thrombosis, active cancer or an antibody in the coagulation system. Of less importance is the eventual presence of a genetic thrombophilia. Possible strategies for avoidance of recurrences are discussed.

Résumé

Le traitement de la thrombose veineuse (TVP) aiguë est standardisé, effectif et sûr. La prévention des récidives est moins bien établie. Le traitement aux anticoagulants prévient des récidives avec une haute certitude mais est associé à un risque considérable d’hémorragies sévères. Après la discontinuation de l’anticoagulation on observe des récidives avec une fréquence entre 0 et >20%. Un risque relativement faible est présent s’il s’agit d’une TVP secondaire à un événement transitoire, si le traitement a été exécuté correctement, si les cailloux ont complètement disparus et le taux des D-dimères est normalisé. Le risque de récidives est relativement élevé si la TVP était idiopathique de nature, associée avec un cancer ou un anticorps dans le système de l’hémostase. La présence d’une éventuelle thrombophilie moléculaire y joue un moindre rôle. Le rapport discute des stratégies utile à réduire les risques de récidives avec un minimum d’effort et de coûts.

Schlüsselwörter

Venöse Thromboembolie - Rezidivprophylaxe

Keywords

Deep-vein thrombosis - prevention of recurrence

Mots clés

Thrombose veineuse profonde - prévention de récidives

Full Text

References

Literatur
1 Abdollahi M, Cushman M, Rosendahl FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost 2003; 89: 493-8.
2 Agnelli G, Prandoni P, Santamaria MG. et al. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med 2001; 345: 165-9.
3 Baglin T, Luddington R, Brown K. et al. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 2003; 362: 523-6.
4 Bates SM, Ginsberg JS. Treatment of deep-vein thombosis. N Engl J Med 2004; 351: 268-77.
5 Blättler W, Kreis-Bovenzi N, Blättler I. Practicability and quality of outpatient management of acute deep venous thrombosis. J Vasc Surg 2000; 32: 855-60.
6 Bauersachs R, Hach-Wunderle V, Landgraf H. et al. Leitlinien zur Diagnostik und Therapie der Venenthrombose und Lungenembolie; Deutsche Gesellschaft für Angiologie. VASA. 2002 31: Suppl 60.
7 Becattini C, Agnelli G, Prandoni P. et al. Longterm clinical outcome of patients with pulmonary embolism: a prospective multicenter study. J Thromb Haemost 2003; 1 (Suppl 1): OC178.
8 Blättler W, Gerlach HE, Partsch H. et al. Deutsche Gesellschaft für Phlebologie. Leitlinie zur Diagnostik und Therapie der Bein- und Beckenvenenthrombose. Phlebologie 2003; 32: 157-63.
9 Bombeli T, Piccapietra B, Boersma A. et al. Decreased anticoagulant response to tissue factor pathway inhibitor in patients with venous throm- boembolism and otherwise no evidence of hereditary or acquired thrombophilia. Thromb Haemost 2004; 91: 80-6.
10 Brandjes DP, Büller HR, Heijboer H. et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759-62.
11 British Thoracic Society.. Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Lancet 1992; 340: 873-6.
12 Büller HR, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2004; 126: 401S-28S.
13 Büller HR, Prins MH. Secondary prophylaxis with warfarin for venous thromboembolism. N Engl J Med 2003; 349: 702-4.
14 Caprini JA, Arcelus JI, Reyna JJ. et al. Deep vein thrombosis outcome and the level of oral anticoagulation therapy. J Vasc Surg 1999; 30: 805-12.
15 Carlin AJ, Farquharson RG, Quenby SM. et al. Prospective observational study of bone mineral density during pregnancy: low-molecular-weight heparin versus control. Hum Reprod 2004; 19: 1211-4.
16 Crowther MA, Ginsberg JS, Julian J. et al. A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med 2003; 349: 1133-8.
17 Dahm A, Van Hylckama Vlieg A, Bendz B. et al. Low level of tissue factor pathway inhibitor (TFPI) increase the risk of venous thrombosis. Blood 2003; 101: 4387-92.
18 Douketis JD, Johnson JA, Turpie AG. Low-molecular- weight heparin as bridging anticoagualtion during interruption of warfarin: assessment of a stardardized periprocedural anticoagulation regimen. Arch Intern Med 2004; 164: 1319-26.
19 Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med 2003; 163: 901-8.
20 Egger B, Schweizer W, Wagner HE. Das akute Abdomen bei Bauchwandblutung unter Antikoagulation. Helv Chir Acta 1992; 59: 399-402.
21 Eichinger S, Weltermann A, Minar E. et al. Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism. Arch Intern Med 2004; 164: 93-6.
22 Farooq V, Hegarty J, Chandrasekar T. et al. Serious adverse incidents with the usage of low molecular weight heparins in patients with chronic kidney disease. Am J Kidney Dis 2004; 43: 531-7.
23 Fattorini A, Crippa L, Vigano S. et al. Risk of deep vein thrombosis recurrence: high negative predictive value of D-dimer performed during oral anticoagulation. Pathophysiol Haemost Thromb. 2002 32 (suppl 2).
24 Franco V, Polanczyk CA, Clausell N. et al. Role of dietary vitamin K intake in chronic oral anticoagulation: prospective evidence from observational and randomised protocols. Am J Med 2004; 116: 651-6.
25 Frank D, Blättler W. Vergleich von ambulanter und stationärer Behandlung der akuten tiefen Beinvenenthrombose: subjektive und ökonomische Aspekte. Schweiz Med Wschr 1998; 128: 1328-33.
26 Geerts WH, Pineo GF, Heit JA. et al. Prevention of venous thromboembolism. Chest 2004; 126: 338S-400.
27 Gerlach H, Blättler W. Kontrollierte Einführung der ambulanten Behandlung der akuten tiefen Beinvenenthrombose – Machbarkeitsstudie an 827 Patienten. Phlebologie 2002; 31: 77-84.
28 Goldhaber SZ. Pulmonary embolism. Lancet 2004; 363: 1295-305
29 Gruel Y, Pouplard C, Nguyen P. et al. Biological and clinical features of low-molecular-weight heparin- induced thrombocytopenia. Brit J Haematol 2003; 121: 786-92.
30 Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism: a statement for health care professionals. Thromb Haemost 2002; 86: 1156-60.
31 Hirsh J, Warkentin TE, Shaughnessy SG. et al. Heparin and low-molecular-weight heparin: Mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest 2001; 119: 64-94S.
32 Hirsh J. The optimal duration of anticoagulant therapy for venous thrombosis. N Engl J Med 1995; 332: 1710-1.
33 Hudgens SA, Cella D, Caprini CA. et al. Deep vein thrombosis: Validation of a patient-reported leg symptom index. Health Qual Life Outcomes 2003; 1: 76-84.
34 Hull RD, Pineo GF, Mah AF. et al. A randomised trial evaluating long-term low-molecular-weight heparin therapy for three months versus intravenous heparin followed by warfarin sodium. J Thromb Haemost 2003; 1 (suppl 1): OC395.
35 Hull RD, Raskob GE, Brant RF. et al. The importance of initial heparin treatment on long term clinical outcome of antithrombotic therapy. The merging theme of delayed recurrence. Arch Intern Med 1997; 157: 2317-21.
36 Hyers TM, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2001; 119 (Suppl) 176S-93.
37 Johansson LC, Frison L, Logren U. et al. Influence of age on the pharmacokinetics and pharmacodynamics of ximegalatran, an oral direct thrombin inhibitor. Clin Pharmacokinetics 2003; 42: 381-92.
38 Juhan C, Alimi Y, Barthelemy P. et al. Late results of iliofemoral venous thrombectomy. J Vasc Surg 1997; 25: 417-42.
39 Kakkar AK, Levine MN, Kadziola Z. et al. Low molecular weight heparin therapy with dalteparin and survival in advanced cancer: The fragmin advanced malignanacy outcome study (FAMOUS). J Clin Oncol 2004; 15: 1944-8.
40 Kearon C, Ginsberg JS, Kovacs MJ. et al. Comparison of low-intensity warfarin therapy with conventional- intensity warfarin therapy of recurrent venous thromboembolism. N Engl J Med 2003; 349: 631-9.
41 Kraemer Nielsen H, Husted SE, Krusell LR. et al. Silent pulmonary embolism in patients with deep venous thrombosis. Incidence and fate in a randomized, controlled trial of anticoagulation versus no anticoagulation. J Int Med 1994; 235: 457-61.
42 Krishnan JA, Segal JB, Streiff MB. et al. Treatment of venous thromboembolism with low-molecularweight heparin: a synthesis of the evidence published in systematic literature reviews. Respir Med 2004; 98: 376-86.
43 Lee AYY, Levine MN, Baker RI. et al. Low-molecular- weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in cancer patients. N Engl J Med 2003; 349: 146-53.
44 Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta- analysis. Ann Intern Med 2003; 139: 893-900.
45 Mismetti P, Laporte-Simitidis S. Aging and venous thromboembolism influence the pharmacokinetics of the Anti-Factor Xa and Anti-thrombin activities of a low molecular weight heparin (Nadroparin). Thromb Haemost 1998; 79: 1162-5.
46 Palareti G, Legnani C, Cosmi B. et al. Predicitve value of D-dimer test for recurrent venous thromboembolism after anticoagulation withdrawal in subjects with a previous idiopathic event and in carriers of congenital thrombophilia. Circulation 2003; 108: 313-8.
47 Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low-molecular-weight heparin. J Vasc Surg 2000; 32: 861-9.
48 Pautas E, Gouin I, Bellot O. et al. Safety profile of Tinzaparin administered once daily at a standard curative dose in two hundred very elderly patients. Drug Safety 2002; 25: 725-33.
49 Pinede L, Ninet J, Duhaut P. et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf vein thrombosis. Circulation 2001; 103: 2453-60.
50 Prandoni P, Lensing AW, Prins MH. et al. Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 2002; 137: 955-60.
51 Prandoni P, Lensing WA, Prins MH. et al. Belowknee elastic compression stockings to prevent the post-thrombotic syndrome. A randomised, controlled trial. Ann Intern Med 2004; 141: 249-56.
52 Raschke R, Hirsh J, Guidry JR. Suboptimal monitoring and dosing of unfractionated heparin in comparative studies with low-molecular-weight heparin. Ann Intern Med 2003; 6: 720-3.
53 Ridker PM, Goldhaber SZ, Danielson E. et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348: 1425-34.
54 Sanderink GJCM, Guimart CG, Ozoux ML. et al. Pharmacokinetics and pharmacodynamics of the prophylactic dose of enoxaparin once daily over 4 days in patients with renal impairment. Thromb Res 2002; 105: 225-31.
55 Scarabin PY, Oger E, Plu-Bureau G. et al. Differential association of oral and transdermal therapy with venous thromboembolism risk. Lancet 2003; 362: 428-32.
56 Schmidt B, Michler R, Klein M. et al. Ultrasound screening for distal vein thrombosis is not beneficial after major orthopedic surgery. A randomised controlled trial. Thromb Haemost 2003; 90: 949-54.
57 Schulman S, Granqvist S, Holmstrom M. et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism: The Duration of Anticoagulation Trial Study Group. N Engl J Med 1997; 334: 336-98.
58 Schulman S, Rhedin AS, Lindmarker P. et al. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 1995; 332: 1661-5.
59 Schulman S, Wählander K, Lundström T. et al. Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximegalatran. N Engl J Med 2003; 349: 1713-21.
60 Schwarcz TH, Mathews MR, Hartford JM. et al. Surveillance venous duplex is not clinically useful after total joint arthroplasty when effective deep venous thrombosis prophylaxis is used. Ann Vasc Surg 2004
61 Siguret V, Pautas E, Férrier M. et al. Elderly patients treated with Tinzaparin (innohep®) administered once daily (175 Anti-XaIU/kg): Anti-Xa and anti-IIa activities over 10 days. Thromb Haemost 2000; 84: 800-4.
62 Siguret V, Pautas E, Gouin I. Low molecular weight heparin treatment in elderly subjects with or without renal insufficiency: new insights between June 2002 and March 2004. Curr Opin Pulm Med 2004; 10: 366-70.
63 Thorevska N, Amoateng-Adjepong Y, Sabahi R. et al. Anticoagulation in hospitalized patients with renal insufficiency: A comparison of bleeding rates with unfractionated heparin versus enoxaparin. Chest 2004; 125: 856-63.
64 Torn M, van der Meer FJ, Rosendaal FR. Lowering the intensity of oral anticoagulant therapy: effect on the risk of hemorrhage and thromboembolism. Arch Intern Med 2004; 164: 668-73.
65 Van der Heijden JF, Hutten BA, Büller HR. et al. Vitamin K antagonists or low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism (Cochrane Review). In: The Cochrane Library 2003; 1.
66 Verhagen HJ, Tolenaar PL, Sybrandy R. Haematoma of the rectus abdominis muscle. Eur J Surg 1993; 159: 335-8.