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Hi my name is my topic is a pixel and to preemptiveness through imbalance in patient with cancer definition patients with active cancer have an increased risk of venous thrombones the quran score identifications with cancer are laboratories for bte who call benefit from thromboprophylaxis epixone therapy results in a significant lover right of venus drawing
Volumes that the placebo are more intermittent to high-risk ambulatory patients with cancer who were studying chemotherapy the array of major blending repeated solids was higher with a pixel venous thromboembolism or vte for sure is a leading cause of death worldwide in the western world someone develops a vte every 16 seconds manifestations of the disease are
Deep vein thrombosis and pulmonary embolism the disease process starts often in one of the large veins of the leg with the formation of a blood clot this can be due to vessel wall injuries a pathological increase in the coagulability of the blood or circulation deficits such as venous stasis the resulting blood clot consists mostly of red blood cells held loosely
Together by strands of fibrin there is a considerable risk of such a fragile clot or parts of it breaking away and traveling with the bloodstream through the heart and into the lungs here the clot or fragment of clot eventually blocks a pulmonary artery the consequence pulmonary embolism the affected area of the lung is no longer available for the oxygenation
Of blood this life-threatening outcome can be traced back to an inappropriately triggered physiological process blood coagulation various medical conditions are associated with disrupted blood coagulation and therefore an increased risk of vte for instance immobilization heightens the risk of hypercoagulability of the blood and venostasis patients undergoing
Major orthopedic surgery such as total hip or knee replacement have an additional risk of vascular injury application amazing a pixel number of prophylaxis has significantly have further thromboembolic complications compared to placebo regarding major blending it was significable increased in a pixel in the group of patients with intention to trip patients
With cancer have an increased risk of venous thromboembolism but parenteral thromboprophylaxis is not routinely recommended in practice guidelines because the absolute risk reduction is modest and parenteral thromboprophylaxis is associated with an increased risk of major bleeding as well as the inconvenience of daily injections could a direct oral anticoagulant
Such as apixaban used as a thromboprophylactic agent in patients with cancer offer advantages over parenteral agents particularly with regard to convenience the randomized placebo-controlled double-blind avert trial included ambulatory patients with cancer who are at intermediate to high risk for venous thromboembolism with a karana score of two or more the corona
Score has been validated to identify patients with cancer who are at elevated risk for thromboembolism the trial patients were randomized to apixaban for thromboprophylaxis before chemotherapy or to placebo before chemotherapy the primary outcome was objectively documented venous thromboembolism over a period of 180 days in a modified intention to treat analysis
Venous thromboembolism occurred in 4.2 percent of the 288 patients in the apixaban group and 10.2 percent of the 275 patients in the placebo group the number needed to treat to prevent venous thromboembolism was 17. the main safety outcome was major bleeding major bleeding occurred in 10 patients in the apixaban group and 5 patients in the placebo group the authors
Conclude that a pixaban at the initiation of chemotherapy resulted in significantly lower rates of venous thromboembolism than did placebo among intermediate to high-risk ambulatory patients with cancer the rate of major bleeding episodes was higher with a pixaban than with placebo full trial results are available at nejm.org do so pros and cons pros
The use of direct oral anticoagulants has thromboprophylactic agents in patients with cancer can offer important advantage over parenteral agents including road of administration commitments and cons guns that was attributed to pulmonary embolums if there was no other explanation to or there was autopsy or radiologic and confirmation of pulmonary embolisms i’m
Dr gary lyman i’m professor of medicine at the university of washington in seattle the american society of hematology has undertaken a very bold effort to develop guidelines across the spectrum of clinical situations where venous thromboembolism becomes a major clinical problem ash has decided to really reinvigorate the guideline process and to do it in what i
Consider the most rigorous and exhaustive some of the things that i think are going to be really exciting about the roll out of these guidelines are that since the last guidelines were published we now have four new drugs that are available on the market for people to prescribe and we don’t have any guideline information about how to use those and so one of the
Things that was really exciting for our panel is that we are able to dig in and try to make some recommendations about how to use those drugs in the treatment of people with venous thromboembolic disease and it was really exciting but it was also challenging because the drugs aren’t new enough that a lot of the information about questions that people are grappling
With there might not have been as much evidence but the really great thing was is in the room and the panel discussing this were the experts and the people that really have their finger on the pulse of what’s going on out there clinically a novel thing about these guidelines is that the plan is is to continually update them as much as possible in real time and so
I think our panel will get the opportunity to add additional information and as new drugs come onto the market there’s many that are in the pipeline right now we’ll be able to add to the recommendations that we’ve made and continue to inform people about the optimal use of anticoagulant drugs 2000 inhabitants is estimate the speed being a multifactorial entity
One of the main cause is the period prolonged birth separatory period presently a race of between 15 and age percent in patients who have not received prophylaxis producing pe with a mortality between 0.2 and 0.9 percent of cases conclusion in conclusion a pixel act address of 2.5 milligrams to twice daily results in a significant lower risk of venous trouble
Limbs than the placebo among ambulatory patients with cancer who were innocent chemotherapy and hack and internality to high risk of venezuelan volumes thank you
Transcribed from video
Apixaban to Prevent Venous Thromboembolism in Patients with Cancer By Karla Guevara Davalos
