CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 10, November 2012
AFRICA
575
monitoring.
Trial data in support of rivaroxaban
include the EINSTEIN DVT study, which
indicated that symptomatic recurrent VTE
for the rivaroxaban arm was non-inferior
to standard therapy of enoxaparin plus
VKA. The EINSTEIN PE trial, the only
currently published study of a single-
agent approach specifically for the
treatment of symptomatic PE, revealed
that rivaroxaban was non-inferior to
enoxaparin plus VKA for the prevention
of symptomatic recurrent VTE.
In the EINSTEIN Extension study,
rivaroxaban was significantly superior
to placebo with regard to symptomatic
recurrent VTE and was associated with
a relative risk reduction of 82%. Major
bleeding was infrequent and occurred in
0.7%
of patients.
Dr Cohen concluded by saying that
the novel oral anticoagulants have been
shown to be effective and have good
safety in the treatment of VTE. Only
oral rivaroxaban, given in a dose of 15
mg twice daily for three weeks for acute
therapy, followed by 20 mg once daily,
provides a simple single-drug approach
for short-term treatment and continued
prevention of VTE.
A single-agent approach also allows
for the simplifying of complicated
guidelines. An example is the American
College of Chest Physicians (ACCP) 9th
antithrombotic guidelines, consisting of
117
different recommendations.
Dr Tunnicliffe presented a surgeon’s
perspective on VTE interventions,
initially emphasising that the surgeon
does not see VTE early enough and that
aggressive early intervention may prevent
early PE death. He noted that while
anticoagulants will prevent propagation
of clot and prevent PE, the existing clot is
still a concern. Spontaneous lysis is often
incomplete, with residual obstruction
resulting in vascular hypertension.
‘
Anticoagulation
alone
is
probably insufficient in most cases of
proximal DVT’, stated Dr Tunnicliffe,
recommending clot removal when
anticoagulation proves inadequate. He
also noted that the long-term outcomes
of anticoagulation in the young were not
promising.
A thrombectomy under general
anaesthetic entails catheter extraction of
the clot through a groin incision. Operative
mortality is very low, although there is a
risk of groin complications, rethrombosis
and very rarely, PE. Cost is a consideration
as the hospital stay may exceed 10 days.
Prof Jacobs pondered on the practical
realities of VTE. Of primary concern is
the pre-emptive avoidance of the first
clot. In terms of the initial event, it is
essential to ascertain whether the clot was
provoked or idiopathic in origin, in order
to appropriately intervene. A good family
history will often give clues to causation.
Prof Jacobs emphasised the need for
simple referral guidelines. He concluded
that ‘most underestimate the impact of
smoking on the vascular system.’
G Hardy
‘
Only oral rivaroxaban, given in a dose
of 15 mg twice daily for three weeks for
acute therapy, followed by 20 mg once
daily, provides a simple single-drug
approach for short-term treatment and
continued prevention of VTE.’
Dr Cohen
MARK YOUR
CALENDAR
17-22
FEBRUARY 2013
CAPE TOWN, SOUTH AFRICA
6
th
Paediatric Cardiology & Cardiac Surgery
SOUTHAFRICAN
HEARTASSOCIATION
Conference Secretariat
Contact the conference secretariat
or visit
Hosted by:
COME TOCAPE TOWN...
PROGRAMME TRACKS
•
Surgery, anaesthesia and intensive care
•
Catheter interventions from fetus to adult
•
Health systems and heart disease
•
Adults with congenital and acquired heart disease
•
Cardiology and the imaging revolution
A trendy, sophisticated, multi-cultural city at the foot of Africa in a diverse and
beautiful natural environment. Cape Town is a destination with irresistable appeal.
South Africa has a compelling history and with its abundance of game reserves
o ers visitors a uniquely di erent cultural and tourist experience.
The most distinguished international faculty available makes the “6th World
Congress” an attractive, interactive and unique meeting place for clinicians,
scientists health care managers and policy developers from all across our world.
Event Dynamics
P.O Box 6761, Roggebaai, 8012, South Africa
Telephone: +27(0) 21 408 9796
Fax: +27(0) 21 408 9954
E-mail:
