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Stephan Moll, MD writes (last updated: Sept 9th, 2020)… Background: Hospitalized patients with COVID-19 are at increased risk for thrombosis – DVT, PE, and may be pulmonary micro-vascular thrombosis that possibly contributes to respiratory failure; arterial events appear to occur less commonly. Scientific/clinical data on prevalence of thrombosis, best prevention, and optimal therapy are limited.
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Stephan Moll, MD writes… Can the patient with acute DVT or PE safely fly, or should he/she wait for a few weeks before embarking on airline travel? It appears safe to fly early: There is no evidence that flying early after the diagnosis of VTE leads to an increased risk of recurrent VTE or embolization
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Stephan Moll, MD and Damon Houghton, MD write … In patients with antiphospholipid syndrome (APS) who require anticoagulation for the treatment of DVT or PE, warfarin or a low molecular weight heparin have traditionally been used. A question that comes up is whether one of the new oral anticoagulants (DOACs) can be effectively and safely
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Stephan Moll, MD writes… On June 23, 2017, the FDA approved a 5th new oral anticoagulant for clinical use, Bevyxxa® (= Betrixaban). It is approved to prevent DVT and PE in patients who are significantly immobile during and after hospitalization for an acute medical illness. Full prescribing information: here. FDA details: here. In the APEX study
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Stephan Moll, MD writes: Athletes with DVT or PE and on anticoagulation face significant challenges returning to full athletic activities. A recent publication of the American College of Cardiology discusses individualized management regimens that may return athletes to return to their sport – http://www.bit.ly/2erRLc0. Last updated: Oct 30th, 2016
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Stephan Moll, MD writes… The FDA did NOT approve Andexanet (brand names: AndexXa™ in the US, IndexXa™ in Europe) in a decision on August 18th, 2016. Andexanet is the antidote in clinical development to reverse the anticoagulant effect of Eliquis® (rivaroxaban), Savaysa® (edoxaban), Xarelto® (rivaroxaban) and Lovenox® (enoxaparin). The FDA is said to have requested more information from
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Stephan Moll, MD writes… Interesting and noteworthy observations published in the last 2 weeks: Heavy menstrual bleeding appears to occur more commonly with Xarelto® than with warfarin [ref 1] and may be also more common with Xarelto® than with Eliquis® [ref 2].
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Stephan Moll, MD writes… Interesting and clinically relevant publication this week [ref 1]. It is well known that estrogens and certain progestin preparations increase the risk for venous thromboembolism (VTE). A woman on an anticoagulant may have heavy menstrual bleeds and hormonal therapy – such as estrogen-progestin contraceptives – may be considered to decrease the bleeding.
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Stephan Moll, MD writes… Our medical center (University of North Carolina Hospitals, Chapel Hill) has put together a comprehensive “Emergent Anticoagulation Reversal Guideline” for our local use, updated since its last edition in 2014 with information about Pradaxa® reversal (with Praxbind®). It is a practical, clinical how-to document (2016 PDF here ). Colleagues and hospitals are welcome to take the
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Stephan Moll, MD writes… An article for patients discussing (a) IVC filters, (b) narrowing of the main left pelvic vein (May-Thurner syndrome) and (c) pelvic venous stents has just been published (http://circ.ahajournals.org/content/133/6/e383.full.pdf). Color images of anatomy, filters and stents are included as visual aids. The article may be helpful as handout material for patients in
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Stephan Moll, MD writes… A new consensus guidance on management of venous thromboembolism (VTE) – link here – was published today, Jan 18th, 2016, in the Journal of Thrombosis and Thrombolysis. The publication contains 13 chapters on various aspects of VTE
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