Aspects of the clinical management of hereditary thrombophilia: a personal perspective.
There is a paucity of evidence-based medicine regarding the clinical management of patients with inherited thrombophilia, and randomized controlled multinational clinical trials of anticoagulant prophylaxis, particularly of secondary prophylaxis, in this population are urgently required. For acute episodes of venous thromboembolism, no data suggest that patients with thrombophilia should be treated differently to those without thrombophilia. Based on the results of a retrospective study, it is recommended that all thrombophilic individuals receive short-term thromboprophylaxis with unfractionated heparin or low-molecular-weight heparin when they are to be exposed to circumstantial risk factors (e.g. surgery, prolonged immobilization, pregnancy and puerperium). In the absence of specifically designed clinical trials, secondary prophylaxis should be based on common sense and clinical experience. From this standpoint, it is recommended that low-risk patients be treated with oral anticoagulants for 6 months, whereas high-risk patients should receive lifelong anticoagulant therapy. Which treatment strategy to adopt for intermediate-risk patients is more controversial -- prolongation of oral anticoagulant therapy to at least 12 months is suggested.
Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, IRCCS Maggiore Hospital and University of Milan, Milan, Italy. piermannuccio.mannucci@unimi.it
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D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D019090:Case Management; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy; D011644:Puerperal Disorders / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013923:Thromboembolism / Q000517:prevention & control; D019851:Thrombophilia / Q000188:drug therapy* / Q000235:genetics
D000925:Anticoagulants