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Published on: February 26, 2013
[Pulmonary artery thrombosis: strategy of anticoagulation]
O Ya Porembskaya1,2, V N Kravchuk1, K V Lobastov3
1Mechnikov North-Western State Medical University, St. Petersburg, Russia.
Insights
Primary artery thrombosis (PAT) can be an independent condition requiring specific management. Current guidelines for pulmonary embolism (PE) inform anticoagulation strategies for PAT in the absence of dedicated studies.
Area of Science:
- Cardiology
- Vascular Medicine
- Thrombosis Research
Background:
- Primary artery thrombosis (PAT) has historically been viewed as a component of venous thromboembolic events, particularly pulmonary embolism (PE).
- Emerging evidence suggests PAT can manifest as an independent condition, distinct from venous thromboembolism.
- PAT exhibits unique clinical signs as both a primary and recurrent event, necessitating tailored treatment approaches.
Purpose of the Study:
- To review the current understanding and management strategies for primary artery thrombosis (PAT).
- To explore the potential for PAT to occur independently of other thromboembolic conditions.
- To discuss the application of existing pulmonary embolism (PE) guidelines to PAT anticoagulation (AC) in the absence of specific PAT research.
Main Methods:
- Review of existing literature and clinical trial data (e.g., PADIS-PE, ASPIRE, EINSTEIN-PE, Hokusai-VTE) pertaining to pulmonary embolism (PE).
- Analysis of data from studies on isolated PE to infer potential anticoagulation (AC) strategies for PAT.
- Examination of current guidelines from various medical societies regarding anticoagulation (AC) for venous thromboembolism.
Main Results:
- Primary artery thrombosis (PAT) can occur as an independent event, separate from venous thromboembolism.
- Anticoagulation (AC) is generally recommended for all cases of PE, with an exception for isolated subsegmental PAT in ambulatory patients.
- The duration of anticoagulation (AC) for PAT should be determined by the presence of major or minor risk factors.
Conclusions:
- In the absence of dedicated studies on primary artery thrombosis (PAT) anticoagulation (AC), current guidelines for pulmonary embolism (PE) should guide treatment decisions.
- Anticoagulation (AC) is advised for most PAT cases, excluding isolated subsegmental PAT in ambulatory individuals.
- The use of anticoagulation (AC) for PAT secondary to chronic inflammatory diseases remains an area requiring further investigation.
Abstract:
This review is devoted to the management of primary artery thrombosis (PAT). This disease was always considered only as a part of other venous thromboembolic events, in particular isolated pulmonary embolism (PE). Various studies show that PAT can develop as an independent event without concomitant damage to extra-vessels. PAT is characterized by own typical signs as primary and recurrent event that can determine special strategies of treatment. However, there are no studies devoted to this problem. We can only make some assumptions about PAT anticoagulation (AC) considering data on isolated PE comprising PAT. These data are available in PADIS-PE, ASPIRE, EINSTEIN-PE, Hokusai-VTE studies underlying modern guidelines of various societies. In the absence of studies on PAT AC these guidelines should regulate PAT AC approaches. AC is recommended in all cases of PE except isolated subsegmental PAT in ambulatory patients. Duration of AC depends on risk factors (major or minor). Anticoagulation for PAT following chronic inflammatory diseases is still disputable.
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