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Results: Progression of thrombus length and volume (40% vs. 28%; P < .001)

Deep Vein Thrombosis. Initial Treatment: Compression & Ambulation. Results: Progression of thrombus length and volume (40% vs. 28%; P < .001) Reduced pain with compression and ambulation ( P < .001) Reduced edema ( P < .001) No new PE on V/Q scan. 1. Blattler W., et al

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Results: Progression of thrombus length and volume (40% vs. 28%; P < .001)

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  1. Deep Vein Thrombosis Initial Treatment: Compression & Ambulation Results: • Progression of thrombus length and volume (40% vs. 28%; P< .001) • Reduced pain with compression and ambulation (P< .001) • Reduced edema (P< .001) • No new PE on V/Q scan 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 Study Stopped @ Interim Analysis Percent per Patient Year Endpoint 3 Mos >1 Year RRR P-value Recurrent VTE 24.1 1.3 95% <0.001 Major Bleed 3.8 - 0.09 0 (non-fatal) Kearon C et al NEJM 1999;340;901.

  4. Acute DVT Duration of Anticoagulation 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

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

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

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

  8. Acute DVT: Anticoagulation Low-Intensity vs. Conventional • 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 Kearon, et al NEJM 2003;349:631-9

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

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

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