fondaparinux and Carotid-Stenosis

Superficial vein thrombosis (SVT) occurs at least as frequent as deep vein thrombosis (DVT), and shares common risk factors with venous thromboembolism. The CALISTO trial was the first to provide specific recommendations for the pharmacologic treatment of SVT. Before treatment is initiated, an accompanying DVT must be excluded and the proximal extension of the SVT assessed. If the proximal extension of the thrombus is closer than 3 cm towards the deep vein system, it should be treated like DVT. Under certain conditions treatment with fondaparinux is indicated in acute symptomatic SVT. Furthermore, compression treatment is recommended. Extracranial carotid artery stenosis can be treated by either surgical thrombarterectomy or catheter based endovascular stent implantation. Trials comparing the two methods have not provided conclusive results on whether the two strategies are equally safe and effective. Considering the latest data from RCTs, careful patient selection (symptoms, comorbidities, age, anatomy, re-stenosis) including individual interdisciplinary discussion appears of ample importance. To date no information is available on whether patients with asymptomatic high grade carotid stenosis receiving "best medical therapy" should be considered for revascularisation in general or only in selected circumstances.

Topics: Angioplasty; Anticoagulants; Carotid Artery, External; Carotid Stenosis; Endarterectomy, Carotid; Fondaparinux; Humans; Multicenter Studies as Topic; Myocardial Infarction; Polysaccharides; Prospective Studies; Pulmonary Embolism; Randomized Controlled Trials as Topic; Risk Factors; Stents; Stockings, Compression; Stroke; Survival Rate; Venous Thrombosis