cover image: Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism

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Low-molecular weight heparins versus warfarin for the long-term prevention or treatment of deep vein thrombosis or pulmonary embolism

2013

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are two significant healthcare concerns related to one single coagulation disorder: venous thromboembolism (VTE). DVT usually occurs in the lower extremities, but the thrombus may dislodge and travel to the lungs to cause PE, which is associated with increased morbidity and mortality. Various inherited or acquired risk factors and disorders result in a state of hypercoagulability and may increase the occurrence of VTE, especially when several combine in a given patient. Anticoagulation is the cornerstone of VTE primary prevention in at-risk patients, as well as VTE treatment and subsequent secondary prevention.1,2 Anticoagulants aim at preventing further thrombus extension, avoid VTE recurrence and preclude the development of complications, but also lead to an increased risk of bleeding complications. In most uncomplicated cases, the American College of Chest Physicians 2012 Clinical Practice Guidelines recommend oral anticoagulation using a vitamin K antagonist such as warfarin, with initial anticoagulation achieved through parenteral treatment with low molecular weight heparins (LMWHs), fondaparinux or unfractionated heparin. Newer oral anticoagulants are currently recommended as alternatives to the aforementioned treatment options; emerging evidence will likely help define their place in therapy. In some particular populations, such as in the presence of cancer or in patients who are unable to use warfarin, extended anticoagulation with LMWH is the preferred treatment option. Treatment durations vary according to the nature of the risk factors for VTE. This Rapid Response report aims to provide further information regarding the comparative clinical and cost-effectiveness of LMWHs versus warfarin for long-term treatment and prevention of DVT and/or PE. This will inform decision-making regarding the reimbursement criteria of LMWHs in a participating jurisdiction.
health cost-benefit analysis research systematic reviews copyright medical research medicine health care therapy clinical trial venous thromboembolism clinical medicine heparin warfarin cost-effectiveness medicare medicaid healthcare policy health treatment health sciences government health care medical specialties anticoagulant deep vein thrombosis anticoagulants (medicine) anticoagulants low molecular weight heparin dvt lmwh anticoagulation lmwhs dvt / pe
Pages
15
Published in
Canada

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