In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in Internal Medicine

SummaryHospitalised medical patients are at increased risk of venous thromboembolism (VTE), but the incidence of hospitalisation-related VTE in unselected medical inpatients has not been extensively studied, and uncertainties remain about the optimal use of thromboprophylaxis in this setting. Aims of our prospective, observational study were to assess the prevalence of VTE and the incidence of symptomatic, hospitalisation-related events in a cohort of consecutive patients admitted to 27 Internal Medicine Departments, and to evaluate clinical factors associated with the use of thromboprophylaxis. Between March and September 2006, a total of 4,846 patients were included in the study. Symptomatic VTE with onset of symptoms later than 48 hours after admission (”hospital-acquired” events, primary study end-point) occurred in 26 patients (0.55٪), while the overall prevalence of VTE (including diagnosis prior to or at admission) was 3.65٪. During hospital stay antithrombotic prophylaxis was administered in 41.6٪ of patients, and in 58.7% of those for whom prophylaxis was recommended according to the 2004 Guidelines of the American College of Chest Physicians. The choice of administering thromboprophylaxis or not appeared qualitatively adherent to indications from randomised clinical trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Data from our real-world study confirm that VTE is a relevant complication in patients admitted to Internal Medicine Departments, and recommended tromboprophylaxis is still under-used, in particular in some patients groups. Further efforts are needed to better define risk profile and to optimise prophylaxis in the heterogeneous setting of medical inpatients.

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Risk factors for venous thromboembolism and prophylaxis in medical inpatients: data from the FADOI ‘‘GEMINI’’ study

Italian Journal of Medicine ◽

10.4081/itjm.2010.23 ◽

2013 ◽

pp. 23-31

Author(s):

Mauro Campanini ◽

Gualberto Gussoni ◽

Mauro Silingardi ◽

Gianluigi Scannapieco ◽

Carlo Buniolo ◽

...

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

Venous Thromboembolism ◽

Bed Rest ◽

Common Finding ◽

Primary Study ◽

Medical Patients ◽

Increased Risk ◽

Medical Inpatients ◽

The Impact

Background: Though venous thromboembolism (VTE) frequently occurs in non-surgical setting, epidemiology and risk factors for VTE in unselected medical inpatients have not been extensively studied, and uncertainties remain about the prophylactic strategy in these patients. Materials and methods: In a prospective, observational, multicenter study we aimed to contemporarily assess the epidemiology of symptomatic VTE in consecutive patients hospitalized in Internal Medicine, to evaluate the impact of potential risk factors, and the attitude of internists towards thromboprophylaxis. A total of 4,846 patients were included, during the period March-September 2006. Results: Symptomatic VTE was registered in 177 (3.65%) patients; of these, 26 cases (0.55%) occurred with onset of symptoms > 48 hours after admission (‘‘hospital-acquired’’ events, primary study end-point). Previous VTE and bed resting were significantly associated with venous thromboembolism, while a trend for increased risk was documented in cancer patients. During hospital stay antithrombotic prophylaxis was globally administered in 41.6% of patients, and in 58.4% of those for which prophylaxis was recommended according to 2004 guidelines by the American College of Chest Physicians. The choice of administering tromboprophylaxis appeared qualitatively adherent to indications from randomized trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Conclusions: Data from our real-world study confirm that VTE is a quite common finding in patients admitted to Internal Medicine departments, and recommended tromboprophylaxis is still underused, in particular in some patients groups. Further efforts are needed to better define the risk profile and to optimize prophylaxis in the heterogeneous setting of medical patients.

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Influence of tranexamic acid use on venous thromboembolism risk in patients undergoing surgery for spine tumors

Journal of Neurosurgery Spine ◽

10.3171/2021.1.spine201935 ◽

2021 ◽

pp. 1-11

Author(s):

Zach Pennington ◽

Jeff Ehresman ◽

Andrew Schilling ◽

James Feghali ◽

Andrew M. Hersh ◽

...

Keyword(s):

Venous Thromboembolism ◽

Tranexamic Acid ◽

Vertebral Column ◽

Comprehensive Cancer Center ◽

Primary Study ◽

High Dose ◽

Data Set ◽

Web Based ◽

Spine Tumors ◽

Increased Risk

OBJECTIVE Patients with spine tumors are at increased risk for both hemorrhage and venous thromboembolism (VTE). Tranexamic acid (TXA) has been advanced as a potential intervention to reduce intraoperative blood loss in this surgical population, but many fear it is associated with increased VTE risk due to the hypercoagulability noted in malignancy. In this study, the authors aimed to 1) develop a clinical calculator for postoperative VTE risk in the population with spine tumors, and 2) investigate the association of intraoperative TXA use and postoperative VTE. METHODS A retrospective data set from a comprehensive cancer center was reviewed for adult patients treated for vertebral column tumors. Data were collected on surgery performed, patient demographics and medical comorbidities, VTE prophylaxis measures, and TXA use. TXA use was classified as high-dose (≥ 20 mg/kg) or low-dose (< 20 mg/kg). The primary study outcome was VTE occurrence prior to discharge. Secondary outcomes were deep venous thrombosis (DVT) or pulmonary embolism (PE). Multivariable logistic regression was used to identify independent risk factors for VTE and the resultant model was deployed as a web-based calculator. RESULTS Three hundred fifty patients were included. The mean patient age was 57 years, 53% of patients were male, and 67% of surgeries were performed for spinal metastases. TXA use was not associated with increased VTE (14.3% vs 10.1%, p = 0.37). After multivariable analysis, VTE was independently predicted by lower serum albumin (odds ratio [OR] 0.42 per g/dl, 95% confidence interval [CI] 0.23–0.79, p = 0.007), larger mean corpuscular volume (OR 0.91 per fl, 95% CI 0.84–0.99, p = 0.035), and history of prior VTE (OR 2.60, 95% CI 1.53–4.40, p < 0.001). Longer surgery duration approached significance and was included in the final model. Although TXA was not independently associated with the primary outcome of VTE, high-dose TXA use was associated with increased odds of both DVT and PE. The VTE model showed a fair fit of the data with an area under the curve of 0.77. CONCLUSIONS In the present cohort of patients treated for vertebral column tumors, TXA was not associated with increased VTE risk, although high-dose TXA (≥ 20 mg/kg) was associated with increased odds of DVT or PE. Additionally, the web-based clinical calculator of VTE risk presented here may prove useful in counseling patients preoperatively about their individualized VTE risk.

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Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies

Thrombosis and Haemostasis ◽

10.1160/th11-03-0168 ◽

2011 ◽

Vol 106 (10) ◽

pp. 600-608 ◽

Cited By ~ 20

Author(s):

Sharon Welner ◽

Maria Kubin ◽

Kerstin Folkerts ◽

Sylvia Haas ◽

Hanane Khoury

Keyword(s):

Venous Thromboembolism ◽

Care Delivery ◽

Risk Groups ◽

Considerable Proportion ◽

Medical Illness ◽

Medical Patients ◽

Vte Prophylaxis ◽

Medically Ill ◽

Medical Inpatients ◽

Clear Identification

SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.

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Prevention of venous thromboembolism in hospitalized patients with chronic kidney disease

Italian Journal of Medicine ◽

10.4081/itjm.2010.269 ◽

2013 ◽

pp. 269-276

Author(s):

Marcora Mandreoli ◽

Antonio Santoro

Keyword(s):

Renal Failure ◽

Venous Thromboembolism ◽

Renal Disease ◽

Case Reports ◽

Current Evidence ◽

High Morbidity ◽

Medical Patients ◽

Medically Ill ◽

Increased Risk ◽

Therapeutic Doses

Despite the high morbidity and mortality associated with venous thromboembolism in hospitalized medical patients with a number of risk factors, and large evidence that prophylaxis is effective, prophylaxis rates remain elusive in medically ill patients. Furthermore, in patients with renal failure, prophylaxis often is omitted or sub-optimal, due to fear of provoking hemorrhage. Patients with end-stage renal disease often have platelet deficits. Low molecular weight heparin (LMWH) therapy may also be difficult to manage in these cases because LMWH clearance is largely dependent on the kidneys. Administration of LMWH to patients with some degree of renal failure may lead to bioaccumulation of anti-Xa activity with an increased risk of bleeding. In recent years, LMWH has largely replaced unfractionated heparin (UFH) for the treatment and prophylaxis of thromboembolic disease. LMWHs have been shown to be superior to UFH in the prevention of venous thromboembolism. They are also easier to administer and do not require laboratory monitoring. However, several case reports and a metaanalysis indicate that the use of LMWHs at therapeutic doses in patients with advanced renal failure can be associated with major bleeding with serious adverse effects. In this paper, we review recent evidence supporting the safety of LMWHs at prophylactic doses in patients with mild or moderate renal disease. Current evidence suggests that bioaccumulation of enoxaparin (the most widely used LMWH) can occur when the drug is used at standard therapeutic doses in patients with severely impaired renal function. This risk can be reduced by empiric dose reduction or monitoring of anti-Xa heparin levels.

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Real-world economic burden of venous thromboembolism and antithrombotic prophylaxis in medical inpatients

Thrombosis Research ◽

10.1016/j.thromres.2012.10.008 ◽

2013 ◽

Vol 131 (1) ◽

pp. 17-23 ◽

Cited By ~ 11

Author(s):

Gualberto Gussoni ◽

Emanuela Foglia ◽

Stefania Frasson ◽

Luca Casartelli ◽

Mauro Campanini ◽

...

Keyword(s):

Venous Thromboembolism ◽

Real World ◽

Economic Burden ◽

Antithrombotic Prophylaxis ◽

Medical Inpatients ◽

World Economic

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Risk assessment and prevention of venous thromboembolism among hospitalized patients: Results of the regional multicenter study

Atherothrombosis Journal ◽

10.21518/2307-1109-2021-11-1-26-40 ◽

2021 ◽

pp. 26-40

Author(s):

A. B. Sugraliyev ◽

Sh. S. Aktayeva ◽

Sh. B. Zhangelova ◽

S. A. Shiller ◽

Zh. M. Kussymzhanova ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Multicenter Study ◽

Bed Rest ◽

Primary Objective ◽

Hospitalized Patients ◽

Public Health Issue ◽

Medical Patients ◽

Pharmacological Prophylaxis ◽

Vte Prophylaxis

Introduction. Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multicenter study was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the regions of Kazakhstan.Materials and methods. Standardized case report forms were filled by trained medical doctors on one predefined day in selected hospitals. Data were analyzed by independent biostatistician. Risk of VTE was categorized according to Caprini score which was recommended by 2004 American College of Chest Physicians (ACCP) guidelines.Results. 432 patients from 4 regions of Kazakhstan; 169 (39.10%) medical patients and 263 (60.9%) surgical patients were eligible for the study. Patients were at low (10%), moderate (19.2%), high (33.6%) and very high risk (37.3%) for VTE. The main risk factors (RF) of VTE among hospitalized patients were heart failure (HF), obesity, prolonged bed rest, and the presence of acute non-infective inflammation. From total number of hospitalized patients with RF with indications to VTE prophylaxis, 58.1% of patients received pharmacological prophylaxis and only 24.6% of them received VTE prophylaxis according ACCP. On the other hand, 23.5% patients with the risk of VTE but who were not eligible for it received pharmacological prophylaxis.Conclusion. These results indicate the existence of inconsistency between eligibility for VTE prophylaxis on one hand and its application in practice (p < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.

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Relative and Absolute Platelet Count Drops As a Risk Factor for Mortality, Bleeding, and Venous Thrombosis in Hospitalized Medical Patients

Blood ◽

10.1182/blood.v126.23.2258.2258 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2258-2258

Author(s):

Matthew E. Lebow ◽

Michael DeSarno ◽

Damon Eugene Houghton ◽

John P. Winters ◽

Samuel A. Merrill ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Intensive Care ◽

Platelet Count ◽

Inflammatory Disease ◽

Medical Patients ◽

Respiratory Dysfunction ◽

Full Dose ◽

Increased Risk ◽

Hospital Acquired

Abstract Introduction: There is little data on the incidence and consequences of hospital-acquired (HA) platelet count drops and no consensus on how to define HA-thrombocytopenia. We evaluated the incidence of relative and absolute HA-drops in platelet count among medical patients (general medicine, cardiology, and intensive care unit) to determine their association with mortality, HA-venous thromboembolism (VTE), and HA-bleeding. Methods: Data was abstracted from the electronic medical record at the University of Vermont Medical Center, a 540-bed tertiary care hospital in Burlington, VT for admissions between 2009-12. Exclusion criteria were age <18, pregnant, admitted to a non-medical service or to the oncology service, and platelet count <150 thousand (k) at admission. HA-platelet count drops were defined as listed in the table (absolute nadir, relative drop, absolute platelet count). We used logistic regression to evaluate the association of various definitions of platelet count drops with HA-VTE, HA-bleeding (based on the International Society of Thrombosis and Haemostasis definition), and in-hospital mortality. Models were adjusted for age, sex, service, admission platelet count, and for known risk factors for HA-VTE, HA-bleeding, and mortality (Table). Results: Of 11,863 admissions without thrombocytopenia on admission, 1,905 (16.1%) patients developed a platelet count <150k, 6,971 (58.8%) had at least a 10% drop in their platelet count, and 6,737 (56.8%) at least a 25k drop (Table). There were 939 (7.9%) deaths, 48 (0.4%) HA-VTE, and 106 (0.9%) HA-bleeding events. HA-platelet count drops were associated with increasing age, male sex, and admission to an intensive care unit (all p < 0.05). All definitions of platelet count drops were associated with mortality, HA-VTE, and HA-bleeding (Table). A 10% platelet count drop was associated with increased mortality (OR 1.52, CI: 95% 1.30-1.79), HA-VTE (OR 5.19, CI: 95% 1.83-14.74), and HA-bleeding (OR 8.83, CI: 95% 3.20-24.36) and an absolute 25k drop was associated with increased mortality (OR 1.60, CI: 95% 1.36-1.88), HA-VTE (OR 4.27, CI: 95% 1.64-11.11), and HA-bleeding (OR 5.22, CI: 95% 2.38-11.49). Conclusion: Platelet count drops, even those considered clinically insignificant, identify a large number of hospitalized medical patients at increased risk for mortality, HA-VTE, and HA-bleeding. Our findings are not driven by severe HA-thrombocytopenia as only 2% of admissions developed platelet counts <100,000. HA-platelet count drops are likely a good marker of illness severity in this population and could identify patients at increased risk for mortality, HA-VTE and HA-bleeding allowing targeted interventions to improve patient outcomes. Table 1. Association of Hospital-Acquired Platelet Count Drops with Mortality, HA-VTE and HA-Bleeding in Medical Patients Platelet Drop Admissions = 11,863 Odds Ratio (95% Confidence Interval) N, % Mortality N = 939 HA-VTE N = 48 HA-Bleeding N = 106 Absolute Nadir <150k 1,905 (16.1%) 2.0 (1.7, 2.5) 4.3 (2.3, 7.9) 2.7 (1.8, 4.2) <100k 235 (2.0%) 4.4 (3.0, 6.3) 5.4 (2.3, 12.5) 3.2 (1.8, 5.8) Relative Drop 50% 371 (3.1%) 3.8 (2.8, 5.2) 6.3 (3.1, 12.8) 5.0 (3.1, 8.0) 30% 1,748 (14.7%) 2.5 (2.1, 3.0) 4.2 (2.2, 7.9) 3.6 (2.3, 5.6) 10% 6,971 (58.8%) 1.5 (1.3, 1.8) 5.2 (1.8, 14.7) 8.8 (3.2, 24.4) Absolute Drop 100k 1,186 (10.0%) 2.7 (2.2, 3.3) 6.4 (3.2, 12.8) 4.3 (2.8, 6.8) 75k 2,019 (17.0%) 2.4 (2.0, 2.3) 5.0 (2.6, 9.9) 4.8 (3.1, 7.7) 50k 3,594 (30.3%) 1.9 (1.7, 2.3) 3.3 (1.7, 6.6) 5.5 (3.2, 9.4) 25k 6,737 (56.8%) 1.6 (1.4, 1.9) 4.3 (1.6, 11.1) 5.2 (2.4, 11.5) Mortality - Adjusted additionally for: Respiratory Rate, Respiratory Dysfunction (intubated or oxygen saturation <90%), Heart Rate, Temperature, Diabetes, Cancer, and HIV (Brabrand, PLoS ONE 2015) HA-VTE - Adjusted additionally for: Anticoagulation (prophylactic and full dose), Cancer, Heart Failure, Respiratory Dysfunction, Rheumatologic or Inflammatory Disease, and Tachycardia (Zakai, JTH 2013) HA-Bleeding - Adjusted additionally for: Anticoagulation (prophylactic and full dose), Cancer, Renal Function, Heart Failure, Respiratory Dysfunction, Rheumatologic or Inflammatory Disease, and Tachycardia (Decousis, Chest 2011) Disclosures No relevant conflicts of interest to declare.

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Venous Thromboembolism Prophylaxis in Acute Medically Ill Patients: A Retrospective Cohort Study

Blood ◽

10.1182/blood-2019-124495 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3678-3678

Author(s):

Anat Gafter-Gvili ◽

Genady Drozdinsky ◽

Oren Zusman ◽

Shiri Kushnir ◽

Leonard Leibovici

Keyword(s):

Internal Medicine ◽

Cohort Study ◽

Venous Thromboembolism ◽

High Risk ◽

Retrospective Cohort ◽

Medical Patients ◽

Vte Prophylaxis ◽

Medically Ill ◽

Pharmacologic Prophylaxis ◽

Medically Ill Patients

Background and Aims Venous thromboembolism (VTE) is considered as a preventable cause of death for hospitalized patients. Current guidelines recommend pharmacologic prophylaxis for medical patients considered high risk for VTE, despite failure of studies to show reduction in mortality. We aimed to assess the benefit and safety of VTE prophylaxis in acutely ill medical patients hospitalized in internal medicine wards. Methods Retrospective cohort study of all patients admitted to the internal medicine and acute geriatric departments, with an admission lasting more than 48 hours, during 2012-2018. Patients who received pharmacologic prophylaxis were compared to those who did not. The primary outcome was 30-day mortality. Secondary outcomes were the 90 day incidence of pulmonary embolism (PE), symptomatic deep vein thrombosis (DVT), and major bleeding. Propensity-weighted logistic multivariable analysis was performed. Results A total of 18890 patient-unique episodes were included in the analysis. Of them 3206 (17%) received prophylaxis. A total of 1309 (6.9%) died. 540/1309 (41.3%) of those who received VTE prophylaxis died and 769/1309 (58.7%) of those who did not receive prophylaxis died. VTE Prophylaxis was not associated with a reduction in mortality, multivariate-adjusted OR 0.99 (95% CI 0.84-1.14). One hundred and forty two patients (0.7%) developed VTE. The frequency of VTE among patients who received VTE prophylaxis was 31% (44/142) compared with 69% (98/142) in patients who did not receive prophylaxis. The frequency of VTE in patients who had a Padua score ≥4 and received VTE prophylaxis, was 1.9% (30/1573) compared with 1.6% (44/2797) in those with a Padua score ≥4 who did not receive prophylaxis. 74/142 (52.1%) of patients with VTE had a Padua score ≥4, 44/1309 (1.4%) of those who received VTE prophylaxis and 98/15864 (0.6%) of those who did not. VTE Prophylaxis was not associated with reduction in VTE in the whole cohort, multivariable-adjusted OR 1.09 (95% CI 0.52-2.29). VTE prophylaxis was associated with an increase in major bleeding (multivariable-adjusted OR 1.24, 95% CI 1.04-1.48) Conclusion The current practice of routinely administering VTE prophylaxis to medically ill patients considered at high risk for VTE, resulted in a high risk for bleeding a without clear clinical benefit, and should be reassessed. Disclosures No relevant conflicts of interest to declare.

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PP018 Clinical Risk Prediction Scores For Venous Thromboembolism In Hospitalized Patients

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317002094 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 76-76

Author(s):

Matthew Mitchell ◽

Nikhil Mull ◽

Todd Hecht ◽

Craig Umscheid

Keyword(s):

Venous Thromboembolism ◽

Risk Prediction ◽

External Validation ◽

Risk Of Bias ◽

Hospitalized Patients ◽

Surgical Patients ◽

Medical Patients ◽

National Guidelines ◽

Clinical Risk ◽

Increased Risk

INTRODUCTION:Risk prediction scores have been devised to identify patients at increased risk for Venous Thromboembolism (VTE) in different patient populations and settings. Guideline recommendations for VTE risk assessment vary greatly. We performed a systematic review to synthesize evidence on clinical risk prediction scores for VTE in hospitalized medical and surgical patients.METHODS:We systematically searched Medline, EMBASE, Cochrane, National Institute of Health and Care Excellence (NICE), National Guidelines Clearinghouse (NGC), and Guidelines International Network (GIN) databases up to March 2016. We included studies validating risk prediction scores for adult hospitalized patients. We excluded studies for any of the following reasons: non-English publication, conducted in non-OECD (Organisation for Economic Co-operation and Development) countries, validation cohorts focused solely on critical care patients, or scores developed for specific surgical or medical sub-specialty populations. We plotted receiver operating characteristic (ROC) curves of included studies and performed summary ROC meta-analyses for scores in which >1 external validation studies were combinable. Risk of bias was assessed qualitatively. We assessed the strength of the evidence base using Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS:We screened 110 primary studies and included 18 of those for analysis. There were seven studies of the Caprini score, three studies of the Padua score, two studies of the IMPROVE score; and one study each of the Arcelus, Geneva, Khorana, RAP, and Kucher scores . Strength of evidence was downgraded for study risk of bias because most studies disproportionately included patients at high risk of VTE. Our summary estimates of the performance of the three combinable scores at clinically-relevant thresholds are: Caprini score at a threshold of three in surgical patients – 96 percent sensitivity, 44 percent specificity; IMPROVE at a threshold of one in medical patients – 96 percent sensitivity, 20 percent specificity; and Padua at a threshold of 4–87 percent sensitivity and 58 percent specificity.CONCLUSIONS:There is moderate strength evidence for use of the Caprini score to predict VTE in surgical patients and for the Padua and IMPROVE scores in medical patients. Lower thresholds may be warranted to achieve sufficient sensitivity to identify low risk populations who may not require routine VTE prophylaxis. Studies making direct comparisons of risk prediction scores in similar patient populations are lacking and are necessary to ascertain which score is most effective.

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Prevention of Venous Thromboembolism in Acutely Ill Medical Patients: A New Era

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0041-1723018 ◽

2021 ◽

Vol 42 (02) ◽

pp. 308-315

Author(s):

Kira MacDougall ◽

Alex C. Spyropoulos

Keyword(s):

Venous Thromboembolism ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Preventive Strategy ◽

Medical Patients ◽

New Era ◽

Medically Ill ◽

Increased Risk ◽

Medically Ill Patients ◽

Patient Subgroups

AbstractVenous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.

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