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Although thromboembolism, including deep venous thrombosis and pulmonary embolism, is a common diagnosis, it is nonetheless a very discouraging one. While it may be unpleasant for us to treat patients who suffer a DVT or acute PE, we see only a portion of what they actually endure. After discharge, chances are we will never see them again.
I often think about how burdensome it will be for my patients to have to see a doctor regularly and have their warfarin (Coumadin) dose adjusted based on the current international normalized ratio (INR), which seems to fluctuate at the drop of a dime.
Most of us have treated patients ranging from robust young men who suffered a PE after a simple arthroscopic knee procedure from a sports injury to sweet, elderly little ladies who have no meaningful transportation to and from the doctor’s office. We worry about how compliant they will be with their prescribed regimen.
When given the diagnosis and treatment, patients almost universally ask how long they will have to stay on warfarin, and many are visibly upset when given the not-so-good news that they should plan to take it for 6 months, maybe longer.
Complications of warfarin therapy are common: the hematocrit of 18 or the hard-to-control epistaxis. But since there is no Food and Drug Administration–approved alternative for managing thromboembolism for the necessary 6 months or so, we have no choice but to prescribe this drug, counsel patients on signs of occult bleeding, and hope for the best. When facing the potential for a fatal pulmonary embolism, the risk-benefit ratio is unquestionably in favor of taking this drug for the vast majority of patients.
But what about the recurrent episodes of DVT or PE after stopping anticoagulation? It is well known that the risk for recurrence persists for years after discontinuing warfarin, particularly in those who had an unprovoked venous thromboembolism. Well, for the first time in ages, there is very encouraging news we can give our patients.
An article published recently in the New England Journal of Medicine, Aspirin for Preventing the Recurrence of Venous Thromboembolism, sheds light on a very simple therapy that can make a huge impact (2012; 366:1959-67). The Aspirin for the Prevention of Recurrent Venous Thromboembolism study randomized patients who had suffered a first-ever, objectively confirmed, symptomatic unprovoked proximal DVT within 2 weeks of discontinuing vitamin K antagonist therapy. Aspirin 100 mg daily was compared with placebo for 2 years.
Researchers found that aspirin therapy, started after 6-18 months of oral anticoagulant therapy, decreased the rate of recurrent venous thromboembolism by 40% when compared with placebo, with no significant increase in the risk of major bleeding. Finally, good news for our patients with DVT/PE. Hooray!
While we will rarely be the ones discontinuing warfarin after 6 months, just letting our patients know that aspirin therapy can decrease the risk of future events can be very reassuring.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
Although thromboembolism, including deep venous thrombosis and pulmonary embolism, is a common diagnosis, it is nonetheless a very discouraging one. While it may be unpleasant for us to treat patients who suffer a DVT or acute PE, we see only a portion of what they actually endure. After discharge, chances are we will never see them again.
I often think about how burdensome it will be for my patients to have to see a doctor regularly and have their warfarin (Coumadin) dose adjusted based on the current international normalized ratio (INR), which seems to fluctuate at the drop of a dime.
Most of us have treated patients ranging from robust young men who suffered a PE after a simple arthroscopic knee procedure from a sports injury to sweet, elderly little ladies who have no meaningful transportation to and from the doctor’s office. We worry about how compliant they will be with their prescribed regimen.
When given the diagnosis and treatment, patients almost universally ask how long they will have to stay on warfarin, and many are visibly upset when given the not-so-good news that they should plan to take it for 6 months, maybe longer.
Complications of warfarin therapy are common: the hematocrit of 18 or the hard-to-control epistaxis. But since there is no Food and Drug Administration–approved alternative for managing thromboembolism for the necessary 6 months or so, we have no choice but to prescribe this drug, counsel patients on signs of occult bleeding, and hope for the best. When facing the potential for a fatal pulmonary embolism, the risk-benefit ratio is unquestionably in favor of taking this drug for the vast majority of patients.
But what about the recurrent episodes of DVT or PE after stopping anticoagulation? It is well known that the risk for recurrence persists for years after discontinuing warfarin, particularly in those who had an unprovoked venous thromboembolism. Well, for the first time in ages, there is very encouraging news we can give our patients.
An article published recently in the New England Journal of Medicine, Aspirin for Preventing the Recurrence of Venous Thromboembolism, sheds light on a very simple therapy that can make a huge impact (2012; 366:1959-67). The Aspirin for the Prevention of Recurrent Venous Thromboembolism study randomized patients who had suffered a first-ever, objectively confirmed, symptomatic unprovoked proximal DVT within 2 weeks of discontinuing vitamin K antagonist therapy. Aspirin 100 mg daily was compared with placebo for 2 years.
Researchers found that aspirin therapy, started after 6-18 months of oral anticoagulant therapy, decreased the rate of recurrent venous thromboembolism by 40% when compared with placebo, with no significant increase in the risk of major bleeding. Finally, good news for our patients with DVT/PE. Hooray!
While we will rarely be the ones discontinuing warfarin after 6 months, just letting our patients know that aspirin therapy can decrease the risk of future events can be very reassuring.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
Although thromboembolism, including deep venous thrombosis and pulmonary embolism, is a common diagnosis, it is nonetheless a very discouraging one. While it may be unpleasant for us to treat patients who suffer a DVT or acute PE, we see only a portion of what they actually endure. After discharge, chances are we will never see them again.
I often think about how burdensome it will be for my patients to have to see a doctor regularly and have their warfarin (Coumadin) dose adjusted based on the current international normalized ratio (INR), which seems to fluctuate at the drop of a dime.
Most of us have treated patients ranging from robust young men who suffered a PE after a simple arthroscopic knee procedure from a sports injury to sweet, elderly little ladies who have no meaningful transportation to and from the doctor’s office. We worry about how compliant they will be with their prescribed regimen.
When given the diagnosis and treatment, patients almost universally ask how long they will have to stay on warfarin, and many are visibly upset when given the not-so-good news that they should plan to take it for 6 months, maybe longer.
Complications of warfarin therapy are common: the hematocrit of 18 or the hard-to-control epistaxis. But since there is no Food and Drug Administration–approved alternative for managing thromboembolism for the necessary 6 months or so, we have no choice but to prescribe this drug, counsel patients on signs of occult bleeding, and hope for the best. When facing the potential for a fatal pulmonary embolism, the risk-benefit ratio is unquestionably in favor of taking this drug for the vast majority of patients.
But what about the recurrent episodes of DVT or PE after stopping anticoagulation? It is well known that the risk for recurrence persists for years after discontinuing warfarin, particularly in those who had an unprovoked venous thromboembolism. Well, for the first time in ages, there is very encouraging news we can give our patients.
An article published recently in the New England Journal of Medicine, Aspirin for Preventing the Recurrence of Venous Thromboembolism, sheds light on a very simple therapy that can make a huge impact (2012; 366:1959-67). The Aspirin for the Prevention of Recurrent Venous Thromboembolism study randomized patients who had suffered a first-ever, objectively confirmed, symptomatic unprovoked proximal DVT within 2 weeks of discontinuing vitamin K antagonist therapy. Aspirin 100 mg daily was compared with placebo for 2 years.
Researchers found that aspirin therapy, started after 6-18 months of oral anticoagulant therapy, decreased the rate of recurrent venous thromboembolism by 40% when compared with placebo, with no significant increase in the risk of major bleeding. Finally, good news for our patients with DVT/PE. Hooray!
While we will rarely be the ones discontinuing warfarin after 6 months, just letting our patients know that aspirin therapy can decrease the risk of future events can be very reassuring.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.