Anticoagulation in Unusual Clinical Scenarios: A Narrative Literature Review
DOI:
https://doi.org/10.17533/udea.iatreia.250Keywords:
Anticoagulants, Embolism and Thrombosis, Nephrotic Syndrome , Heart DefectsAbstract
Introduction: Anticoagulant use in specific clinical scenarios such as venous thromboembolic disease or atrial fibrillation is common, with clearly established management guidelines. However, there is currently no unified clinical guidance for managing thrombosis in unusual scenarios, presenting a significant therapeutic challenge.
Objective: To review the indications for anticoagulation and their regimens in unusual clinical situations based on available evidence.
Methods: A literature review was conducted from 1997 to 2022, using relevant MeSH terms for anticoagulation, oral anticoagulants, embolism, and thrombosis. Information was extracted and synthesized in a structured manner.
Results: In nephrotic syndrome, warfarin is recommended, although alter-natives such as low molecular weight heparins, aspirin, or direct oral anti-coagulants exist. For intracavitary thrombus, warfarin is the drug of choice, with demonstrated equivalent efficacy to direct oral anticoagulants. For peripheral arterial disease, rivaroxaban at vascular protection dose + aspirin has shown benefit in major adverse cardiovascular outcomes depending on individual profile.
Conclusions: Management of these scenarios requires proper clinical assessment and selection of the type of anticoagulant, ensuring maximum reduction of both thrombosis and bleeding risks.
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References
DeWald TA, Washam JB, Becker RC. Anticoagulants: Pharmacokinetics, Mechanisms of Action, and Indications. Neurosurg Clin N Am [Internet]. 2018;29(4):503-515. https://doi.org/10.1016/j.nec.2018.06.003
Altiok E, Marx N. Oral Anticoagulation. Dtsch Arztebl Int [Internet]. 2018;115(46):776-783. https://doi.org/10.3238/arztebl.2018.0776
Schulman S. Optimal duration of anticoagulant therapy. Semin Thromb Hemost [Internet]. 2013;39(2):141-6. https://doi.org/10.1055/s-0032-1333542
Weitz JI. Anticoagulation therapy in 2015: where we are and where we are going. J Thromb Thrombolysis [Internet]. 2015;39(3):264-72. https://doi.org/10.1007/s11239-015-1194-6
Willner NA, Ehrenberg S, Musallam A, Roguin A. Coronary artery ectasia: prevalence, angiographic characteristics and clinical outcome. Open Heart [Internet]. 2020;7(1):e001096. https://doi.org/10.1136/openhrt-2019-001096
Vrachatis DA, Papathanasiou KA, Kazantzis D, Sanz-Sánchez J, Giotaki SG, Raisakis K, et al. Inflammatory Biomarkers in Coronary Artery Ectasia: A Systematic Review and Meta-Analysis. Diagnostics (Basel) [Internet]. 2022;12(5):1026. https://doi.org/10.3390/diagnostics12051026
Eitan A, Roguin A. Coronary artery ectasia: new insights into pathophysiology, diagnosis, and treatment. Coron Artery Dis [Internet]. 2016;27(5):420-8. https://doi.org/10.1097/MCA.0000000000000379
Aboeata AS, Sontineni SP, Alla VM, Esterbrooks DJ. Coronary artery ectasia: current concepts and interventions. Front Biosci (Elite Ed) [Internet]. 2012;4(1):300-310. https://doi.org/10.2741/377
Kataoka Y, Doi T. Coronary artery ectasia: Importance of its risk stratification and management. Int J Cardiol [Internet]. 2021;322:43-44. https://doi.org/10.1016/j.ijcard.2020.08.061
Yasar AS, Erbay AR, Ayaz S, Turhan H, Metin F, Ilkay Et aI. Increased platelet activity in patients with isolated coronary artery ectasia. Coron Artery Dis [Internet]. 2007;18(6):451-4. https://doi.org/10.1097/MCA.0b013e3282a30665
Moghadam RH, Shahmohammadi A, Asgari N, Azizi K, Mansour SM, Roozbahani M. Comparison of mean platelet volume levels in coronary artery ectasia and healthy people: systematic review and meta-analysis. Blood Res [Internet]. 2018;53(4):269-275. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300668/
Dahhan A. Coronary artery ectasia in atherosclerotic coronary artery disease, inflammatory disorders, and sickle cell disease. Cardiovasc Ther [Internet]. 2015;33(2):79-88. https://doi.org/10.1111/1755-5922.12106
Pranata R, Yonas E, Chintya V, Alkatiri AA. Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports. Int J Angiol [Internet]. 2019;28(4):231-236. https://doi.org/10.1055/s-0039-1692706
Almazán A, Nandayapa O, Rangel A, Badui E, Albarrán H, Lepe L. Asymptomatic ischemia in coronary arterial ectasia. Effects of anticoagulation. Arch Inst Cardiol Mex [Internet]. 1997;67(3):195-200. Disponible en: https://pubmed.ncbi.nlm.nih.gov/9412431/
Doi T, Kataoka Y, Noguchi T, Shibata T, Nakashima T, Kawakami S, et al. Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol [Internet]. 2017;37(12):2350-2355. https://doi.org/10.1161/ATVBAHA.117.309683
Sorrell VL, Davis MJ, Bove AA. Current knowledge and significance of coronary artery ectasia: a chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations. Clin Cardiol [Internet]. 1998;21(3):157-60. https://doi.org/10.1002/clc.4960210304
Grigorov V. Invasive and anticoagulant treatment for coronary ectasia: a single operator's experience in a tertiary hospital in South Africa. Cardiovasc J Afr [Internet]. 2009;20(4):229-32. Disponible en: https://pubmed.ncbi.nlm.nih.gov/19701533/
Kerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol [Internet]. 2012;7(3):513-20. https://doi.org/10.2215/CJN.10131011
Lionaki S, Derebail VK, Hogan SL, Barbour S, Lee T, Hladunewich M, et al. Venous thromboembolism in patients with membranous nephropathy. Clin J Am Soc Nephrol [Internet]. 2012;7(1):43-51. https://doi.org/10.2215/CJN.04250511
Welander F, Holmberg H, Dimény E, Jansson U, Själander A. Prophylactic anticoagulants to prevent venous thromboembolism in patients with nephrotic syndrome-A retrospective observational study. PLoS One [Internet]. 2021;16(7):e0255009. https://doi.org/10.1371/journal.pone.0255009
Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am J Kidney Dis [Internet]. 2013;62(3):403-41. https://doi.org/10.1053/j.ajkd.2013.06.002
Hofstra JM, Wetzels JFM. Should aspirin be used for primary prevention of thrombotic events in patients with membranous nephropathy? Kidney Int [Internet]. 2016;89(5):981-983. https://doi.org/10.1016/j.kint.2016.01.019
Zou H, Li Y, Xu G. Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy. BMC Nephrol [Internet]. 2019;20(1):442. https://doi.org/10.1186/s12882-019-1637-y
Lin R, McDonald G, Jolly T, Batten A, Chacko B. A Systematic Review of Prophylactic Anticoagulation in Nephrotic Syndrome. Kidney Int Rep [Internet]. 2019;5(4):435-447. https://doi.org/10.1016/j.ekir.2019.12.001
Kelddal S, Hvas AM, Grove EL, Birn H. Safety and effectiveness of direct oral anticoagulants in patients with nephrotic syndrome: a report of 21 cases. BMC Nephrol [Internet]. 2022;23(1):305. https://doi.org/10.1186/s12882-022-02929-x
McNally MM, Univers J. Acute Limb Ischemia. Surg Clin North Am [Internet]. 2018;98(5):1081-1096. https://doi.org/10.1016/j.suc.2018.05.002
Suggested standards for reports dealing with lower extremity ischemia. Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg [Internet]. 1986;4(1):80-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3723692/
Björck M, Earnshaw JJ, Acosta S, Bastos Gonçalves F, Cochennec F, Debus ES eta al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg [Internet]. 2020;59(2):173-218. https://doi.org/10.1016/j.ejvs.2019.09.006
Akdemir R, Vatan MB. Updates in 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases. Turk Kardiyol Dern Ars [Internet]. 2017;45(8):681-686. https://doi.org/10.5543/tkda.2017.78578
Debus ES, Nehler MR, Govsyeyev N, Bauersachs RM, Anand SS, Patel MR, et al. Effect of Rivaroxaban and Aspirin in Patients With Peripheral Artery Disease Undergoing Surgical Revascularization: Insights From the VOYAGER PAD Trial. Circulation [Internet]. 2021;144(14):1104-1116. https://doi.org/10.1161/CIRCULATIONAHA.121.054835
Mumoll N, Invernizzi C, Luschi R, Carmignani G, Camaiti A, Cel M. Phlegmasia cerulea dolens. Circulation [Internet]. 2012;125(8):1056-7. https://doi.org/10.1161/CIRCULATIONAHA.111.051912
Guzkurt L, Ozkan U, Demirturk OS, Gur S. Endovascular treatment of phlegmasia cerulea dolens with impending venous gangrene: manual aspiration thrombectomy as the first-line thrombus removal method. Cardiovasc Intervent Radiol [Internet]. 2011;34(6):1214-21. https://doi.org/10.1007/s00270-010-0042-5
Ichida F, Hamamichi Y, Miyawaki T, Ono Y, Kamiya T, Akagi T, et al. Clinical features of isolated noncompaction of the ventricular myocardium: long-term clinical course, hemodynamic properties, and genetic background. J Am Coll Cardiol [Internet]. 1999;34(1):233-40. https://doi.org/10.1016/s0735-1097(99)00170-9
Stöllberger C, Blazek G, Dobias C, Hanafin A, Wegner C, Finsterer J. Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction. Am J Cardiol [Internet]. 2011;108(7):1021-3. https://doi.org/10.1016/j.amjcard.2011.05.039
Chimenti C, Lavalle C, Magnocavallo M, Alfarano M, Mariani MV, Bernardini F, et al. A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy. ESC Heart Fail [Internet]. 2022;9(1):241-250. https://doi.org/10.1002/ehf2.13694
Pöyhönen P, Kuusisto J, Järvinen V, Pirinen J, Räty H, Lehmonen L, et al. Left ventricular non-compaction as a potential source for cryptogenic ischemic stroke in the young: A case-control study. PLoS One [Internet]. 2020;15(8):e0237228. https://doi.org/10.1371/journal.pone.0237228
Fazio G, Corrado G, Zachara E, Rapezzi C, Sulafa AK, Sutera L, et al. Anticoagulant drugs in noncompaction: a mandatory therapy? J Cardiovasc Med (Hagerstown) [Internet]. 2008 Nov;9(11):1095-7. https://doi.org/10.2459/JCM.0b013e328308da04
Kido K, Guglin M. Anticoagulation Therapy in Specific Cardiomyopathies: Isolated Left Ventricular Noncompaction and Peripartum Cardiomyopathy. J Cardiovasc Pharmacol Ther [Internet]. 2019;24(1):31-36. https://doi.org/10.1177/1074248418783745
Abdelnaby M, Almaghraby A, Abdelkarim O, Saleh Y, Hammad B, Badran H. The role of rivaroxaban in left ventricular thrombi. Anatol J Cardiol [Internet]. 2019;21(1):47-50. https://doi.org/10.14744/AnatolJCardiol.2018.48313
Habash F, Vallurupalli S. Challenges in management of left ventricular thrombus. Ther Adv Cardiovasc Dis [Internet]. 2017;11(8):203-213. https://doi.org/10.1177/1753944717711139
McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL Jr, Bhatt DL, McEvoy JW. Left Ventricular Thrombus After Acute Myocardial Infarction: Screening, Prevention, and Treatment. JAMA Cardiol [Internet]. 2018;3(7):642-649. https://doi.org/10.1001/jamacardio.2018.1086
Massussi M, Scotti A, Lip GYH, Proietti R. Left ventricular thrombosis: new perspectives on an old problem. Eur Heart J Cardiovasc Pharmacother [Internet]. 2021;7(2):158-167. https://doi.org/10.1093/ehjcvp/pvaa066
Hansen ML, Sørensen R, Clausen MT, Fog-Petersen ML, Raunsø J, Gadsbøll N, et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med [Internet]. 2010;170(16):1433-41. https://doi.org/10.1001/archinternmed.2010.271
Dans AL, Connolly SJ, Wallentin L, Yang S, Nakamya J, Brueckmann M, et al. Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial. Circulation [Internet]. 2013;127(5):634-40. https://doi.org/10.1161/CIRCULATIONAHA.112.115386
O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol [Internet]. 2013;61(4):e78-e140. https://doi.org/10.1016/j.jacc.2012.11.019
Kouvaras G, Chronopoulos G, Soufras G, Sofronas G, Solomos D, Bakirtzis A, et al. The effects of long-term antithrombotic treatment on left ventricular thrombi in patients after an acute myocardial infarction. Am Heart J [Internet]. 1990;119(1):73-8. https://doi.org/10.1016/s0002-8703(05)80084-5
Maniwa N, Fujino M, Nakai M, Nishimura K, Miyamoto Y, Kataoka Y, et al. Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction. Eur Heart J [Internet]. 2018;39(3):201-208. https://doi.org/10.1093/eurheartj/ehx551
Jones DA, Wright P, Alizadeh MA, Fhadil S, Rathod KS, Guttmann O, et al. The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction. Eur Heart J Cardiovasc Pharmacother [Internet]. 2021;7(5):398-404. https://doi.org/10.1093/ehjcvp/pvaa096
Alcalai R, Butnaru A, Moravsky G, Yagel O, Rashad R, Ibrahimli M et al. Apixaban vs. warfarin in patients with left ventricular thrombus: a prospective multicentre randomized clinical trial‡. Eur Heart J Cardiovasc Pharmacother [Internet]. 2022;8(7):660-667. https://doi.org/10.1093/ehjcvp/pvab057
Kido K, Ghaffar YA, Lee JC, Bianco C, Shimizu M, Shiga T, et al. Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus. PLoS One [Internet]. 2021;16(6):e0252549. https://doi.org/10.1371/journal.pone.0252549
Michael F, Natt N, Shurrab M. Direct Oral Anticoagulants vs Vitamin K Antagonists in Left Ventricular Thrombi: A Systematic Review and Meta-analysis. CJC Open [Internet]. 2021;3(9):1169-1181. https://doi.org/10.1016/j.cjco.2021.04.007
Levine GN, McEvoy JW, Fang JC, Ibeh C, McCarthy CP, Misra A, et al. Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. Circulation [Internet]. 2022;146(15):e205-e223. https://doi.org/10.1161/CIR.0000000000001092
Lattuca B, Bouziri N, Kerneis M, Portal JJ, Zhou J, Hauguel-Moreau M, et al. Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus. J Am Coll Cardiol [Internet]. 2020;75(14):1676-1685. https://doi.org/10.1016/j.jacc.2020.01.057
Ding KJ, Cammann VL, Szawan KA, Stähli BE, Wischnewsky M, Di Vece D, et al. Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights From the International Takotsubo Registry. Arterioscler Thromb Vasc Biol [Internet]. 2020;40(1):279-287. https://doi.org/10.1161/ATVBAHA.119.313491
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J [Internet]. 2018;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393
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