Background The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant.

N Engl J Med ; The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant deep-vein thrombosis or symptomatic pulmonary embolism at presentation, have not been established. Full Text of Background In a randomized, double-blind trial, we assigned patients to receive either fondaparinux, administered subcutaneously at a dose of 2.

The primary efficacy outcome was a composite of death from any cause or symptomatic pulmonary embolism, symptomatic deep-vein thrombosis, or symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis at day The main safety outcome was major bleeding.

The patients were followed until day Full Text of Methods The primary efficacy outcome occurred in 13 of patients 0.

The incidence of each component of the primary efficacy outcome was significantly reduced in the fondaparinux group as compared with the placebo group, except for the outcome of death 0. Similar risk reductions were observed at day A total of 88 patients would need to be treated to prevent one instance of pulmonary embolism or deep-vein thrombosis. Major bleeding occurred in one patient in each group. The incidence of serious adverse events was 0.

Full Text of Results Fondaparinux at a dose of 2. Full Text of Discussion Superficial-vein thrombosis of the legs is a common condition, 1,2 with an estimated incidence that may exceed that of deep-vein thrombosis. The treatment of this disease has not been adequately addressed in randomized trials.

Accordingly, the recommendations in various guidelines are weak, and in practice, therapeutic strategies vary, ranging from no treatment to the use of antiinflammatory agents or Lungenembolie in St. Petersburg drugs or surgery. We conducted the Comparison of Arixtra in Lower Limb Superficial Vein Thrombosis with Placebo CALISTO trial to evaluate the efficacy and safety of fondaparinux, a specific factor Xa inhibitor, in reducing symptomatic venous thromboembolic complications or death from any cause in patients with acute, Lungenembolie in St.

Petersburg, isolated superficial-vein thrombosis of the legs. For the active treatment, we selected the Lungenembolie in St. Petersburg dose of 2. Hospitalized or nonhospitalized patients 18 years of age or older, with acute, symptomatic lower-limb superficial-vein thrombosis at least 5 cm long, as confirmed by standardized compression ultrasonography, were eligible to undergo randomization.

Patients were excluded if the interval between the onset of their symptoms and planned randomization was more than 3 weeks; if they had been treated for cancer within the previous 6 months; if they presented with symptomatic or asymptomatic deep-vein thrombosis, symptomatic documented pulmonary embolism, or superficial-vein thrombosis associated with sclerotherapy or placement of an intravenous catheter or located within 3 cm of the Lungenembolie in St.

Petersburg junction; or if they had a documented history of superficial-vein thrombosis within the previous 3 months or deep-vein thrombosis or pulmonary embolism within the previous 6 months. Other exclusion criteria were major surgery within the previous 3 months and conditions that could confer a predisposition to bleeding, including severe hepatic impairment, a creatinine clearance of less than 30 ml per minute, and a platelet count of less thanper cubic millimeter.

Finally, women of childbearing age were excluded if they were pregnant or were not using a reliable contraceptive method. This trial was an international, multicenter, randomized, double-blind, placebo-controlled study; the protocolincluding the statistical analysis plan, is available with the full text of this article at NEJM. With the use of a central telephone system and a computer-generated randomization list, consecutive patients were randomly assigned, Lungenembolie in St.

Petersburg, in a 1: Randomization was Lungenembolie in St. Petersburg in blocks of four without any stratification.

The maximum interval allowed between the qualifying ultrasonographic study and randomization was 48 hours. The day of randomization was defined as day 1. No routine ultrasonographic examinations were required during the follow-up period. The study was conducted according to the ethical principles stated in the Declaration of Helsinki and local regulations.

The protocol was approved by an independent ethics committee, and written informed consent was obtained from all patients before they underwent randomization. The study was funded by GlaxoSmithKline. A steering committee, including one Lungenembolie in St. Petersburg member representing the sponsor, was responsible for the design, conduct, and reporting of the study. Data were collected and analyzed by the study sponsor.

The database of adjudicated outcomes was managed by an independent central adjudication committee. The members of the writing committee wrote the first draft of the manuscript and made the decision to submit the manuscript for publication.

All the authors contributed to the writing of subsequent drafts of the manuscript, had full access to the data and analyses, and vouch for the accuracy and completeness of the report, as well as the fidelity of the study to the protocol and statistical analysis plan. Fondaparinux and placebo were packaged in identical boxes containing visually identical, prefilled 0.

Each patient received one box containing 45 single-dose syringes 1 per day for 45 days of either 2. At the time of randomization, patients were provided with an injection diary. The investigators were encouraged to teach the patients to administer the study drugs themselves, but the final decision about self-administration was left to the investigator's discretion. Patients were encouraged to use graduated compression stockings and were allowed to take acetaminophen or topical nonsteroidal antiinflammatory drugs as needed.

The primary efficacy Lungenembolie in St. Petersburg was the composite of death from any cause, symptomatic pulmonary embolism confirmed by ventilation—perfusion scanning, helical computed tomography, pulmonary angiography, or autopsysymptomatic deep-vein thrombosis confirmed by ultrasonography or venographyor symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis confirmed by ultrasonography up to day For definitions of recurrence and extension of superficial-vein thrombosis, see the Supplementary Appendixavailable at NEJM.

Secondary efficacy outcomes were the composite primary efficacy outcome up to day 77 and the following outcomes up to day 47 and day Analyses of safety outcomes were performed with data obtained until day 47 or until 4 days after the last injection of the study drug whichever was longerwith data obtained until 4 days after the last injection of the study treatment on-treatment analysisand with data obtained until day Other safety outcomes were clinically relevant nonmajor, minor, Lungenembolie in St.

Petersburg, and total any bleeding definitions provided in the Supplementary Appendix and arterial thromboembolic events.

All other adverse events that occurred while the patient was receiving treatment were reported. If a thromboembolic or bleeding complication occurred during the course of the study, management of the condition was left to the investigator's discretion. All symptomatic outcomes were reviewed by the central adjudication committee, whose members were unaware of the patients' group assignments. Patient safety was monitored by an independent data and safety monitoring committee. As planned, the independent steering committee, whose members were unaware of the group assignments, monitored the overall event rate for the primary efficacy outcome.

On November 5,on the basis of an observed rate of the primary efficacy outcome of 3. Efficacy analyses were performed on data from the intention-to-treat population, which included all the patients who had undergone randomization. Patients for whom a primary efficacy assessment was lacking i. Safety analyses were performed on data from the as-treated population, which comprised all patients who had undergone randomization and who had received at least one dose of the study drug.

Time-to-event outcomes estimated by means of the Kaplan—Meier method were compared with the use of the log-rank test. A prespecified sensitivity analysis was performed in which patients with missing data on the primary efficacy outcome were excluded. Zelen's exact test was used to verify the consistency of the treatment effect across 16 prespecified sets of subgroups and 1 set of subgroups that was defined post hoc. Between March and Maya total of patients were Lungenembolie in St.

Petersburg at centers in 17 countries see the Supplementary Appendix — in the fondaparinux group and in the placebo group. Of the patients who underwent randomization, 18 patients in the fondaparinux group 1. Overall, patients in the fondaparinux group Of the patients who underwent randomization, 4 patients in the fondaparinux group and 11 in the placebo Lungenembolie in St.

Petersburg received no study drug as a result of the patient's decision, in each caseand 1 patient who was randomly assigned to the placebo group received at least one dose of fondaparinux in error; thus, patients in the fondaparinux group The demographic and clinical characteristics of the patients, the medications and interventions the patients received before their entry into the study Table 1 Table 1 Baseline Characteristics of the Study Patients.

In addition, the treatments other than the study drugs that patients received during the course of the study were well balanced between the two groups, with two exceptions: This result was confirmed in the sensitivity analysis in which patients with a missing primary efficacy assessment were excluded data not shown. The incidence of each component of the primary efficacy outcome was significantly reduced in the fondaparinux group as compared with the placebo group including the incidence of pulmonary embolism [number needed to treat to prevent one pulmonary embolism was ]except for the incidence of death, which did not differ significantly between the two groups.

The primary efficacy outcome was a composite of death from any cause, symptomatic pulmonary embolism, symptomatic deep-vein thrombosis, or symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis. Data from patients who were lost to follow-up were censored at the time of the last contact. The size of each Tabletten bei Thrombophlebitis is in proportion to the number of patients in the comparison.

The analysis of subgroups according to the distance of thrombus from the saphenofemoral junction included only subjects who had a thrombosis involving the great saphenous vein.

No adjustment for multiple comparisons was made, since subgroup analyses were performed for exploratory purposes only, Lungenembolie in St. Petersburg. None of the P values for interaction were less than 0. Results for 12 of the 16 prespecified subgroups are presented; the treatment effect was also consistent within each of the 4 other prespecified subgroups defined according to country and status with respect to receipt of graduated compression stockings, use of nonsteroidal antiinflammatory drugs, and use of aspirin or other antiplatelet agents at baselineas well as the subgroup defined post hoc defined according to Lungenembolie in St.

Petersburg the index superficial-vein thrombosis was in a varicose vein on ultrasonographic examination. The body-mass index is the später Varizen in kilograms divided by the square of the height in meters. ND denotes not determined. Finally, more patients in the placebo group than in the fondaparinux group underwent surgery for superficial-vein thrombosis Table 3including ligation of the saphenofemoral junction, which by day 77 had been performed in 52 patients in the placebo group 3.

By day 47, major girudoterapiya für Schema Krampf Staging wenn Blutegel had occurred in one patient 0. The rates of clinically relevant nonmajor, minor, and total bleeding and arterial thromboembolic complications did not differ significantly between the two groups Table 4 Table 4 Safety Outcomes Lungenembolie in St.

Petersburg to Day Safety results were similar in on-treatment analyses and in analyses at day 77 Table 4 in the Supplementary Appendix. There were no clinically relevant between-group differences in the incidence of any other adverse events Table 5 and Table 6 in the Supplementary Appendix. The only serious adverse event that was reported in more than one patient in either study group was coronary artery disease, which was reported in two patients in the placebo group 0.

No episodes of thrombocytopenia were reported in the fondaparinux group. In this study, Lungenembolie in St. Petersburg, we investigated the effect of anticoagulant therapy as compared with placebo on symptomatic outcomes in patients with isolated superficial-vein thrombosis. Treatment with fondaparinux at a dose of 2. The number needed to treat to prevent one event of the primary efficacy outcome was 20, Lungenembolie in St.

Petersburg, whereas the number needed to treat to prevent deep-vein thromboembolism or a pulmonary embolism was The study was placebo-controlled, Lungenembolie in St. Petersburg, since no standard treatment has been established in this clinical setting, Lungenembolie in St.

Petersburg. The patients in our study are representative of those encountered in routine practice 1,2,8: The rate of symptomatic thromboembolic complications in the placebo group at day 47 5. However, this rate and the corresponding rate at day 77 6. This benefit was evident within the first days after treatment was initiated Figure 1supporting the adequacy of the prophylactic dose of 2, Lungenembolie in St.

Petersburg. Lungenembolie in St. Petersburg number needed to treat to prevent one episode of pulmonary embolism with fondaparinux as compared with placebo in the patients with superficial-vein thrombosis in our study is similar to the number needed to treat with low-molecular-weight heparin as compared with placebo or no treatment in trials of thromboprophylaxis in acutely ill medical patients In addition, more patients in the placebo group than in the fondaparinux group required therapeutic doses of anticoagulant therapy.

A potential limitation of our study is the difficulty in applying the data to clinical practice, Lungenembolie in St.

Petersburg, because a complete ultrasonographic examination was performed in every patient with a suspected superficial-vein thrombosis — first, to confirm the condition, and second, Lungenembolie in St. Petersburg rule out the presence of deep-vein thrombosis.

However, performing a complete ultrasonographic examination may help physicians avoid treating patients who do not have thrombosis and allow the appropriate care of patients Lungenembolie in St.

Petersburg present with concomitant deep-vein thrombosis. The effect of the day fondaparinux regimen on the quality of life was not formally assessed in our study.


Lungenembolie in St. Petersburg Frida Kahlo und Diego Rivera - [ART]

Juli [1] war ein deutscher Politiker CDU. April der Koordinator der Bundesregierung für die transatlantische Zusammenarbeit. Im Rahmen des Deutschlandtags in Hamburg wurde er von den Delegierten einstimmig Lungenembolie in St. Petersburg zum Ehrenvorsitzenden der Jungen Union gewählt.

Er war seit Mitglied des JU-Bundesvorstandes, Lungenembolie in St. Petersburg. Seit gehörte er dem CDU-Bundesvorstand an. Juli für diesen in den Deutschen Bundestag nach. Von Januar bis zum 1. Er starb am Juli im Alter von 35 Jahren an einer Lungenemboliedie nach ärztlichen Angaben als Langzeitfolge eines Treppensturzes im Februar gilt. Juli wurde er in Dülmen - Buldern beigesetzt. Er kritisierte das Vorhaben, das Rederecht für die Abgeordneten mit Minderheitenmeinungen in ihren Fraktionen einzuschränken.

Wer als Abgeordneter nicht mehr ohne juristischen Beistand zu sprechen wagt, kann sein Mandat nur noch eingeschränkt wahrnehmen. Damit stellt sich aber die Frage, warum ihn die Wähler für seine Tätigkeit eigentlich noch bezahlen sollen. Er kritisierte Günter Grass in der Auseinandersetzung um dessen die Politik Israels Lungenembolie in St. Petersburg Gedicht Was gesagt werden muss.

April nahm er an einer privaten Geburtstagsfeier Gerhard Schröders in St. Petersburg teil, die der russische Präsident Wladimir Putin und Gazprom ausgerichtet hatten. Bundesvorsitzende der Jungen Union Deutschlands. Ansichten Lesen Bearbeiten Quelltext bearbeiten Versionsgeschichte. In anderen Projekten Commons Wikiquote. Diese Seite wurde zuletzt am Oktober um Möglicherweise unterliegen Krampfadern und Beingeschwüre Inhalte jeweils zusätzlichen Bedingungen.

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Background The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant.
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Background The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant.
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Diego Rivera galt als der berühmteste Maler Mexikos. Aber die Rollen wandelten sich. Als Frida Kahlo starb, war sie der Star – uns ist es bis heute geblieben.
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Background The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant.
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