Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism?
Introduction. Protocols and guidelines have been improving results of our clinical practice. Sometimes there have been differences between guidelines on the same topic, but they have not been so important usually. As far as the start of vitamin K antagonists (VKA) in a non-high risk pulmonary thromb...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2020-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501900001K.pdf |
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| _version_ | 1850230395745861632 |
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| author | Koraćević Goran Ilić Dragana |
| author_facet | Koraćević Goran Ilić Dragana |
| author_sort | Koraćević Goran |
| collection | DOAJ |
| description | Introduction. Protocols and guidelines have been improving results of our clinical practice. Sometimes there have been differences between guidelines on the same topic, but they have not been so important usually. As far as the start of vitamin K antagonists (VKA) in a non-high risk pulmonary thromboembolism (PTE) patients is concerned, there is global consensus (reflected in all comprehensive guidelines) that it should be on the admission day or a day later. However, there are situations in which this VKA administering from the first (or second) day of hospitalization may actually complicate the treatment. Case report. As an illustration, our female, 71 years old patient with second unprovoked, intermediate-high risk PTE was given low-molecular-weight heparin (LMWH) + VKA from the second day. Due to lack of improvement in symptoms, oxygen saturation and D dimer after 9 days, computed tomography pulmonary angiography (CTPA) was repeated and it confirmed minimal advancement. The patient already had achieved target international normalized ratio (INR) and it complicated proceeding to fibrinolytic therapy. Conclusion. Correction of the therapeutic approach in the PTE treatment may be needed even if the treatment is completely conducted according to the latest guidelines. We recommend postponing VKA from the first (or second) day of hospitalization (as suggested in all available guidelines for non-high risk PTE patients) until satisfying clinical improvement is reached. |
| format | Article |
| id | doaj-art-d02b4fc8d80448f3bbc789e76c917fe8 |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-d02b4fc8d80448f3bbc789e76c917fe82025-08-20T02:03:53ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202020-01-0177121336134110.2298/VSP170121001K0042-84501900001KShould anti-vitamin K be started on the first day in non-high risk pulmonary embolism?Koraćević Goran0Ilić Dragana1University of Niš, Clinical Center Niš, Clinic of Cardiology, Niš, SerbiaUniversity of Niš, Clinical Center Niš, Department of Radiology, Niš, SerbiaIntroduction. Protocols and guidelines have been improving results of our clinical practice. Sometimes there have been differences between guidelines on the same topic, but they have not been so important usually. As far as the start of vitamin K antagonists (VKA) in a non-high risk pulmonary thromboembolism (PTE) patients is concerned, there is global consensus (reflected in all comprehensive guidelines) that it should be on the admission day or a day later. However, there are situations in which this VKA administering from the first (or second) day of hospitalization may actually complicate the treatment. Case report. As an illustration, our female, 71 years old patient with second unprovoked, intermediate-high risk PTE was given low-molecular-weight heparin (LMWH) + VKA from the second day. Due to lack of improvement in symptoms, oxygen saturation and D dimer after 9 days, computed tomography pulmonary angiography (CTPA) was repeated and it confirmed minimal advancement. The patient already had achieved target international normalized ratio (INR) and it complicated proceeding to fibrinolytic therapy. Conclusion. Correction of the therapeutic approach in the PTE treatment may be needed even if the treatment is completely conducted according to the latest guidelines. We recommend postponing VKA from the first (or second) day of hospitalization (as suggested in all available guidelines for non-high risk PTE patients) until satisfying clinical improvement is reached.http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501900001K.pdfpulmonary embolismanticoagulantscomputed tomography angiographylungfibrin fragment dtreatment outcome. |
| spellingShingle | Koraćević Goran Ilić Dragana Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism? Vojnosanitetski Pregled pulmonary embolism anticoagulants computed tomography angiography lung fibrin fragment d treatment outcome. |
| title | Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism? |
| title_full | Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism? |
| title_fullStr | Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism? |
| title_full_unstemmed | Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism? |
| title_short | Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism? |
| title_sort | should anti vitamin k be started on the first day in non high risk pulmonary embolism |
| topic | pulmonary embolism anticoagulants computed tomography angiography lung fibrin fragment d treatment outcome. |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501900001K.pdf |
| work_keys_str_mv | AT koracevicgoran shouldantivitaminkbestartedonthefirstdayinnonhighriskpulmonaryembolism AT ilicdragana shouldantivitaminkbestartedonthefirstdayinnonhighriskpulmonaryembolism |