Venous thromboembolism prophylaxis in medical patients

Current Opinion in Cardiology

Volumn 19, Issue 6, 2004, Pages 570-574

  Michota, Franklin A ^a  

^a LERNER RESEARCH INSTITUTE   (United States)

Author keywords

Anticoagulation; Deep vein thrombosis; Heparin; Low molecular weight heparin; Pulmonary embolism

Indexed keywords

ENOXAPARIN; FONDAPARINUX; HEPARIN; LOW MOLECULAR WEIGHT HEPARIN;

ANTICOAGULATION; BLEEDING; CRITICAL ILLNESS; DEEP VEIN THROMBOSIS; DRUG EFFECT; HIGH RISK PATIENT; HOSPITAL DISCHARGE; HOSPITALIZATION; HUMAN; LUNG EMBOLISM; MORBID OBESITY; OBESITY; PRIORITY JOURNAL; PROPHYLAXIS; REVIEW; SURGICAL PATIENT; VENOUS THROMBOEMBOLISM;

ANTICOAGULANTS; HEPARIN; HUMANS; INPATIENTS; PREMEDICATION; PULMONARY EMBOLISM; THROMBOEMBOLISM; TIME FACTORS;

EID: 8344227580     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.hco.0000141266.88385.67     Document Type: Review

References (36)

1. Hirsh J, Hoak J: Management of deep vein thrombosis and pulmonary embolism: a statement for healthcare professionals. Council on Thrombosis, American Heart Association. Circulation 1996, 93:2212-2245.
2. Heit JA, Silverstein MD, Mohr DN, et al.: Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 1999, 159:445-453.
3. Prandoni P, Lensing AWA, Cogo A, et al.: The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996, 82:1251 -1257.
4. Kearon C: Natural history of venous thromboembolism. Circulation 2003, 107(suppl):122-130. This is an excellent and comprehensive review of the natural history of DVT and PE.
5. Kahn SR, Ginsberg J: Relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med 2004, 164:17-26. This paper reviews the incidence and prevalence of postthrombotic syndrome as it relates to DVT and it stresses the long-term complications of VTE.
6. Silverstein MD, Heit JA, Mohr DN, et al.: Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998, 158:585-593.
7. Heit JA, O'Fallon M, Petterson TM, et al.: Relative impact of risk factors for deep vein thrombosis and pulmonary embolism. Arch Intern Med 2002, 162:1245-1248.
8. Goldhaber SZ, Tapson V: A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004, 93:259-262. This is the largest epidemiologic study of VTE to date. It demonstrates that the majority of hospitalized medical patients do not routinely get prophylaxis in the United States. It also highlights that surgical patients are more likely to get prophylaxis and that UFH is the most common drug-based prevention strategy chosen in the United States.
9. Geerts WH, Heit JA, Clagett GP, et al.: Prevention of venous thromboembolism. Chest 2001, 119(suppl):132S-175S.
10. Belch JJ, Lowe GDO, Ward AG, et al.: Prevention of deep vein thrombosis in medical patients by low dose heparin. Scott Med J 1981, 26:115-117.
11. Cade JF: High-risk of the critically ill for venous thromboembolism. Crit Care Med 1982, 10:448-450.
12. Ibarra-Perez K, Sandset PM: A double-blind and randomized placebo-controlled trial of low dose heparin in the intensive care unit. Semin Thromb Haemost 1988, 11:25-33.
13. Samama MM, Cohen AT, Darmon J-Y, et al.: A comparison of enoxaparin with placebo for the prevention of VTE in acutely ill medical patients. N Engl J Med 1999, 341:793-800.
14. Cohen A, Davidson B, Gallus A, et al.: Fondaparinux for the prevention of VTE in acutely ill medical patients. Blood 2003, 102:15a. This is the last placebo-controlled trial of VTE prevention that will ever be done. More than 1% of the placebo group died of a fatal PE. The results emphasize that average medical patients are at the same risk for DVT and PE as surgical patients. This study also highlights the first new anticoagulant (synthetic factor Xa inhibitor) in medical prophylaxis during the last 5 years (since LMWHs).
15. Arecelus JI, Caprini JA, Monreal M, et al.: The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients. J Vasc Surg 2003, 38:916-922. This paper provides more registry evidence that medical patients are erroneously viewed as being at less risk for DVT and PE than surgical patients, thus they get less protection.
16. Tapson VF, Decousus H, Piovella F, et al.: A multinational observational cohort study in acutely ill medical patients of practices in prevention of venous thromboembolism: findings of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Blood 2003, 102:321a. This article adds to data from DVT-FREE, which highlights that almost two thirds of all medical patients hospitalized worldwide do not get DVT prophylaxis. IMPROVE, unlike DVT-FREE, shows that globally LMWHs are the most common drug-based choice to prevent DVT.
17. Hirsh J, Levine M: Low molecular weight heparin. Blood 1992, 79:1-17.
18. Mismetti P, Laporte-Simitsidis S, Tardy B, et al.: Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular weight heparins: a meta-analysis of randomized clinical trials. Thromb Haemost 2000, 83:14-19.
19. Warkentin TE, Kelton JG: A 14-year study of heparin-induced thrombocytopenia. Am J Med 1996, 101:502-507.
20. Bergman J-F, Neuhart E: A multicenter randomized double-blind study of enoxaparin compared with unfractionated heparin in the prevention of venous thromboembolic disease in elderly inpatients bedridden for an acute medical illness. Thromb Haemost 1996, 76:529-534.
21. Vaitkus PT, Leizorovicz A, Goldhaber SZ: Rationale and design of a clinical trial of a low-molecular-weight heparin in preventing clinically important venous thromboembolism in medical patients: the prospective evaluation of dalteparin efficacy for prevention of venous thromboembolism in immobilized patients trial (the PREVENT study). Vasc Med 2002, 7:269-273.
22. Leizorovicz A: The prospective evaluation of dalteparin efficacy for prevention of venous thromboembolism in immobilized patients trial (the PREVENT study). J Thromb Haemost 2003, 1 (suppl):OC396. This placebo-controlled trial involved an LMWH, demonstrating efficacy in contemporary medical patients. Together with MEDENOX, the LMWHs have been studied in more than 5000 acutely ill, contemporary high-risk medical patients, and they demonstrated efficacy and safety. No such data with UFH exist.
23. Kleber FX, Witt C, Vogel G, et al.: Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J 2003, 145:614-621. This is the most recent head-to-head comparison between an LMWH and UFH. It has a noninferiority design for efficacy, but demonstrated that enoxaparin was safer with respect to bleeding and overall adverse events than UFH.
24. McGarry LJ, Thompson D: Prevention of venous thromboembolism with enoxaparin versus unfractionated heparin in acutely-ill medical inpatients. Blood 2003, 102:320a. This is an administrative database study with some limitations, but it demonstrated with clinical events a significant reduction in thrombosis observed in patients who receive enoxaparin compared with any dose of UFH.
25. Anderson FA, Spencer FA: Risk factors for venous thromboembolism. Circulation 2003, 107(suppl):19-116. This is an excellent and comprehensive review on individual risk factors for DVT/PE and how to apply them in clinical decision making on prophylaxis.
26. Blaszyk H, Bjornsson J: Factor V Leiden and morbjd obesity in fatal postoperative pulmonary embolism. Arch Surg 2000, 135:1410-1413.
27. Wu EC, Barba CA: Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg 2000, 10:7-13.
28. Sanderink GJ, Le Liboux A, Jariwala N, et al.: The pharmacokinetics and pharmacodynamics of enoxaparin in obese volunteers, Clin Pharmacol Ther 2002, 72:308-318.
29. Spinier SA, Inverse SM, Cohen M, et al.: ESSENCE and TIMI 11B Investigators. Safety and efficacy of unfractionated heparin versus enoxaparin in patients who are obese and patients with severe renal impairment: analysis from the ESSENCE and TIMI 11B studies. Am Heart J 2003, 146:33-41. This is a first look at clinical safety in special populations (obesity and renal insufficiency) with LMWHs.
30. Frederiksen SG, Hedenbro JL, Norgren L: Enoxaparin effect depends on body-weight and current doses may be inadequate in obese patients. Br J Surg 2003, 90:547-548. This study provides evidence that obese patients respond to fixed doses of heparin differently than normal weight subjects.
31. Thorevska N, Amoateng-Adjepong Y, Sabahi R, et al.: Anticoagulation in hospitalized patients with renal insufficiency: a comparison of bleeding rates with unfractionated heparin versus enoxaparin. Chest 2004, 125:856-863. This paper adds further support to Spinler's post hoc analysis that all heparins lead to increased bleeding in the setting of renal insufficiency. UFH is not safer to use in this situation. This is crucial, because many clinicians have favored UFH in renally impaired patients over a false sense of security.
32. Geerts W, Selby R: Prevention of venous thromboembolism in the ICU. Chest 2003, 124(suppl):357S-363S. This is an excellent and concise review of what we know about DVT/PE in the critical care unit.
33. Priglinger U, Delle Karth G, Geppert A, et al.: Prophylactic anticoagulation with enoxaparin: is the subcutaneous route appropriate in the critically ill? Crit Care Med 2003, 31:1405-1409. This is the first report emphasizing that critical care patients may need escalated LMWH doses in the intensive care unit to prevent DVT resulting from poor subcutaneous absorption. This is the opposite of what is traditionally believed, because many clinicians have favored UFH (a weaker prophylaxis choice).over, safety concerns.
34. Dobesh PP: Novel concepts: emerging data and the role of extended prophylaxis following hip fracture surgery. Am J Health Syst Pharm 2003, 60(suppl 7):S15-S19.
35. Bergqvist D, ENOXACAN Study Group: Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double-blind randomized multicentre trial with venographic assessment. Br J Surg 1997, 84:1099-1103.
36. Bosson JL, Labarere J, Sevestre MA, et al.: Deep vein thrombosis in elderly patients hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors, prophylaxis, and prevalence. Arch Intern Med 2003, 163:2613-2618. This study highlights that recently hospitalized patients continue to be at high risk for VTE during the posthospitalization period.