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Introduction - An Update on Asprin for DVT Prophylaxis

Rob Orman, MD and Tom Deloughery, MD

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  • Is lifelong anticoagulation needed to prevent recurrent clots for patients with unprovoked thromboembolic events?  Yes, usually.  Patients with large idiopathic PEs and most with idiopathic proximal DVTs should have lifelong anticoagulation.  The recurrence risk is 20-30% in 5 years.  Treatment with warfarin or one of the newer anticoagulants reduces the thrombosis risk by 80-90%.  

    • Some women with no risk factors (not obese, younger than 65, D-dimer on therapy is normal) may not need to be chronically anticoagulated with warfarin.  

  • Does aspirin provide any benefit?  Yes, but it’s not as powerful.  

    • The INSPIRE Collaboration looked at over 1200 patients with first episode unprovoked thromboembolic events.  After completing treatment for their thromboses, patients were treated with either low dose aspirin or placebo and followed for 2 ½ years.  Compared to placebo, aspirin reduced the risk of recurrent DVT and PE by 32% per year.  There was no statistically significant increased risk of bleeding with aspirin therapy.

    • For patients with unprovoked DVT or PE history who will not receive indefinite warfarin or a newer anticoagulant therapy, consider low dose aspirin to reduce the recurrent thrombosis risk.

Simes, John, et al. "Aspirin for the Prevention of Recurrent Venous Thromboembolism: The INSPIRE Collaboration." Circulation (2014): CIRCULATIONAHA-114.  

Monica P. -

One question I was left with is if you Rx gabapentin for anxiety, I got that you can dose a large range but do they just take it prn for episodes or should they take it daily or bid and how quickly will it help with their anxiety attack if they do take it prn? Thank you, this review was so helpful. I find anxiety very difficult to manage and almost always in tandem with depression making it that much for difficult to manage.

Heidi J., MD -

Hey Monica! Thanks for your excellent question; I've passed it along to Dr. Hersevoort and will keep you posted.

Heidi J., MD -

Here's Shawn's reply:

Hi there! Gabapentin treats anxiety primarily by immediate sedation and lowering of sympathetic tone, so think of it like a safer/weaker BZD. It can be used PRN or standing, but would need to be BID or TID for standing.

Sylvianne C. -

Hello, I am going through old podcast summary and I noticed that I can't access link to psychiatry pocket guide. Is that normal? Thank you

Heidi J., MD -

Hi Sylvianne,

Hmmm...seems to be an issue with some older summaries. I'll see if it's fixable.
Good pick up -thanks!

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My Anxieties Have Anxieties Full episode audio for MD edition 204:13 min - 96 MB - M4AHippo Primary Care RAP December 2014 Summary 787 KB - PDF