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Original Article
Aspirin for Preventing the Recurrence of Venous Thromboembolism
The risk of recurrence of venous thromboembolism persists for many years after anticoagulant treatment is withdrawn. This risk is particularly high among patients with unprovoked venous thromboembolism, about 20% of whom have a recurrence within 2 years after treatment with vitamin K antagonists…
- May 24, 2012
- Becattini C., Agnelli G., Schenone A., et al.
- N Engl J Med 2012; 366:1959-1967
- CME
About 20% of patients with venous thrombosis or embolism but no defined risk factors have a recurrence within the first 2 years after stopping anticoagulation therapy. These authors report that 100 mg of aspirin a day nearly halved the risk of recurrence, with no increase in bleeding.
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Editorial
Aspirin and the Prevention of Venous Thromboembolism
Venous thromboembolism, including deep-vein thrombosis and pulmonary embolism, is a common condition, with an annual incidence of 2 to 3 cases per 1000 in the general population. Although the risk of recurrence is only about 1% per year in patients with a transient risk factor (provoked venous…
- May 24, 2012
- Becker R.C.
- N Engl J Med 2012; 366:2028-2030
Venous thromboembolism, including deep-vein thrombosis and pulmonary embolism, is a common condition, with an annual incidence of 2 to 3 cases per 1000 in the general population.¹ Although the risk of recurrence is only about 1% per year in patients with ...
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Original Article
Vorapaxar in the Secondary Prevention of Atherothrombotic Events
Platelets play a central role in atherothrombosis and are an important target for pharmacotherapy. In patients with acute coronary syndromes, the use of potent platelet inhibitors has been shown to reduce the rate of thrombotic events at the cost of increased bleeding.– In contrast, among…
- April 12, 2012
- Morrow D.A., Braunwald E., Bonaca M.P., et al.
- N Engl J Med 2012; 366:1404-1413
Patients with atherosclerotic vascular disease were randomly assigned to receive the thrombin antagonist vorapaxar or placebo. Vorapaxar reduced the rate of subsequent cardiovascular death, myocardial infarction, or stroke but increased the rate of moderate or severe bleeding.
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Original Article
Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism
Pulmonary embolism is a common disease, with an estimated annual incidence of 70 cases per 100,000 population. The condition usually leads to hospitalization and may recur; it can be fatal. For half a century, the standard therapy for most patients with pulmonary embolism has been the…
- April 5, 2012
- The EINSTEIN–PE Investigators
- N Engl J Med 2012; 366:1287-1297
In the treatment of patients with acute pulmonary embolism, the efficacy of rivaroxaban, a factor Xa inhibitor, was similar to that of traditional anticoagulation therapy. There was less bleeding in the group receiving rivaroxaban, which supports its use in the treatment of this condition.
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Images in Clinical Medicine
Westermark Sign in Pulmonary Embolism
Figure 1.
- March 15, 2012
- Krishnan A.S. and Barrett T.
- N Engl J Med 2012; 366:e16
- Free Full Text
A 47-year-old woman presented to the emergency department with acute shortness of breath and hypoxia. Her medical history included sex reassignment, for which she was taking estrogen, and a deep-vein thrombosis on the left side, for which she had required warfarin.
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Correspondence
Bleeding Risk with Dabigatran in the Frail Elderly
To the Editor: Since July 1, 2011, the thrombin inhibitor dabigatran has been available in New Zealand for stroke prevention in patients with atrial fibrillation. There are no restrictions on prescribing, and access is free to patients through government funding. Approximately 7000 patients started…
- March 1, 2012
- N Engl J Med 2012; 366:864-866
- Free Full Text
In an audit of patients who had bleeding events during treatment with dabigatran, common factors included advanced age, impaired renal function, low body weight, and prescriber error.
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Original Article
Semuloparin for Thromboprophylaxis in Patients Receiving Chemotherapy for Cancer
Venous thromboembolism, a common complication in patients with cancer,, results in increased morbidity, mortality, medical care, and cost. In addition to surgery and prolonged hospital stays, chemotherapy is increasingly recognized as a risk factor for venous thromboembolism in patients with cancer.…
- February 16, 2012
- Agnelli G., George D.J., Kakkar A.K., et al.
- N Engl J Med 2012; 366:601-609
Patients with advanced cancer are at increased risk for venous thrombosis and thromboembolism related to both the effects of cancer and its treatment. In this study, semuloparin was shown to reduce the incidence of thromboembolism without affecting the risk of major bleeding.
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Editorial
Routine Heparin for Patients with Cancer? One Answer, More Questions
The antithrombotic effect of heparins is established, and it is speculated that a direct antitumor effect of heparin might translate into a survival benefit in patients with cancer. This antitumor activity of heparins mechanistically includes the inhibition of cell–cell interaction by blocking…
- February 16, 2012
- Akl E.A. and Schünemann H.J.
- N Engl J Med 2012; 366:661-662
The antithrombotic effect of heparins is established, and it is speculated that a direct antitumor effect of heparin might translate into a survival benefit in patients with cancer. This antitumor activity of heparins mechanistically includes the ...
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Images in Clinical Medicine
Pulmonary Cement Embolism after Vertebroplasty
Figure 1.
- January 19, 2012
- Tourtier J.-P. and Cottez S.
- N Engl J Med 2012; 366:258
- Free Full Text
A 61-year-old man with spinal cord compression underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system.
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Original Article
Low-Molecular-Weight Heparin and Mortality in Acutely Ill Medical Patients
Venous thromboembolism is an important complication in hospitalized patients.– It is estimated that if thromboprophylaxis is not administered, objectively diagnosed deep-vein thrombosis — with the potential for fatal pulmonary embolism — will develop in 10 to 20% of medical patients and in 40…
- December 29, 2011
- Kakkar A.K., Cimminiello C., Goldhaber S.Z., et al.
- N Engl J Med 2011; 365:2463-2472
- CME
Thromboprophylaxis with low-molecular-weight heparin is known to prevent deep-vein thrombosis in acutely ill medical patients. This large trial showed no effect of enoxaparin on 30-day mortality, which was virtually identical in the active-treatment and placebo groups.
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Images in Clinical Medicine
Thrombosis of a Mechanical Mitral Valve
Figure 1.
- December 15, 2011
- Harris K.C. and Campbell A.I.M.
- N Engl J Med 2011; 365:e45
- Free Full Text
- Video
An 8-year-old girl with a history of congenital mitral stenosis and mitral-valve replacement presented with dyspnea on exertion, fatigue, and orthopnea. On examination, she had tachypnea, a heart rate of 130 bpm, and oxygen saturation of 85 to 87% while breathing ambient air.
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Original Article
Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients
Venous thromboembolism is a common and potentially fatal complication in hospitalized surgical patients and acutely ill medical patients. The benefits of providing pharmacologic thromboprophylaxis over the entire course of the hospital stay have been validated, with efficacy and safety shown in…
- December 8, 2011
- Goldhaber S.Z., Leizorovicz A., Kakkar A.K., et al.
- N Engl J Med 2011; 365:2167-2177
- CME
In this clinical trial of hospitalized medically ill patients, extended thromboprophylaxis (30 days) with apixaban had similar efficacy to that of a shorter course (6 to 14 days) of subcutaneous enoxaparin. There was more bleeding with apixaban.
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Special Article
Emergency Hospitalizations for Adverse Drug Events in Older Americans
Decreasing the number of preventable rehospitalizations by 20% by the end of 2013 is a goal of the $1 billion federal initiative Partnership for Patients, and the pursuit of this goal represents an opportunity to reduce harm to patients and reduce health care costs. Adverse drug events are a direct…
- November 24, 2011
- Budnitz D.S., Lovegrove M.C., Shehab N., Richards C.L.
- N Engl J Med 2011; 365:2002-2012
- Free Full Text
This national study estimated that nearly 100,000 elderly patients were hospitalized for adverse drug events annually from 2007 through 2009. Most resulted from use of common medications such as warfarin and insulin, and only 1% from medications designated as high-risk.
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Correspondence
Acutely Injured Patients on Dabigatran
To the Editor: Trauma remains the fourth leading cause of death in the United States, with 40,000 deaths annually in persons over the age of 65. U.S. trauma centers are seeing an increasing number of severely injured elderly patients, and hemorrhagic complications and head injuries account for a…
- November 24, 2011
- N Engl J Med 2011; 365:2039-2040
- Free Full Text
The new oral direct thrombin inhibitor, dabigatran, is proving to be problematic in acutely injured patients, since it may promote bleeding and its effect cannot be easily reversed.
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Clinical Therapeutics
Extracorporeal Membrane Oxygenation for ARDS in Adults
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- November 17, 2011
- Brodie D. and Bacchetta M.
- N Engl J Med 2011; 365:1905-1914
- CME
A 41-year-old woman presents with severe pneumonia, and the acute respiratory distress syndrome (ARDS) develops. Despite mechanical ventilation, her oxygenation deteriorates. The use of extracorporeal membrane oxygenation (ECMO) is recommended.
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Perspective
Evaluating Rivaroxaban for Nonvalvular Atrial Fibrillation — Regulatory Considerations
On September 8, 2011, the Cardiovascular and Renal Drugs Advisory Committee of the Food and Drug Administration (FDA) discussed data submitted in support of the new drug application for rivaroxaban for preventing stroke and non–central nervous system systemic embolic events in patients with…
- October 27, 2011
- Fleming T.R. and Emerson S.S.
- N Engl J Med 2011; 365:1557-1559
- Free Full Text
An FDA advisory committee recently considered a new drug application for rivaroxaban for preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation, but there are important concerns about interpretation of the results of the key study.
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Images in Clinical Medicine
Scrotal Calcinosis
Figure 1.
- August 18, 2011
- Grenader T. and Shavit L.
- N Engl J Med 2011; 365:647
- Free Full Text
A 32-year-old man presented to the ER with dyspnea and hemoptysis. On examination, yellowish scrotal nodules that had developed during the past 12 years were noted incidentally. The nodules were painless, firm, and progressively enlarging.
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Clinical Problem-Solving
Looking at the Whole Picture
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 50-year-old woman presented with…
- August 4, 2011
- Donagh C., Bruzzi J., MacNeill B., et al.
- N Engl J Med 2011; 365:448-453
- CME
- Video
A 50-year-old woman presented with rapidly progressive shortness of breath. Five months earlier, she had received a diagnosis of invasive breast carcinoma and had undergone mastectomy. Her fifth cycle of chemotherapy was completed 10 days before presentation.
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Images in Clinical Medicine
Thrombosis of the Inferior Vena Cava and Dilated Veins of the Trunk
Figure 1.
- June 30, 2011
- Roncato C. and Lefant P.Y.
- N Engl J Med 2011; 364:2535
- Free Full Text
An 82-year-old man presented for evaluation of chronic, progressive edema of the legs. He had a history of deep venous thrombosis of the right leg, pulmonary embolism, and the subsequent insertion, 15 years ago, of an inferior vena cava filter.
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Review Article
Current Concepts: Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension is defined as mean pulmonary-artery pressure greater than 25 mm Hg that persists 6 months after pulmonary embolism is diagnosed. The 2008 World Symposium on Pulmonary Hypertension emphasized the importance of chronic thromboembolic pulmonary…
- January 27, 2011
- Piazza G. and Goldhaber S.Z.
- N Engl J Med 2011; 364:351-360
Chronic thromboembolic pulmonary hypertension can develop after acute pulmonary embolus but is often overlooked until pulmonary hypertension has led to dyspnea and right ventricular dysfunction. This review provides a guide to early diagnosis and management.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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