Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients

2010 ◽  
Vol 103 (04) ◽  
pp. 736-748 ◽  
Author(s):  
Alexander Cohen ◽  
Victor Tapson ◽  
Samuel Goldhaber ◽  
Ajay Kakkar ◽  
Bruno Deslandes ◽  
...  
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Disease Severity ◽  
Medical Diagnosis ◽  
Multivariable Analysis ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Global Rate ◽  
Medically Ill Patients

SummaryLimited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40–45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients.

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

Blood ◽  
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.

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

2011 ◽  
Vol 106 (10) ◽  
pp. 600-608 ◽  
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.

scholarly journals Venous Thromboembolism Prophylaxis and Risk for Acutely Medically Ill Patients Stratified by Different Ages and Renal Disease Status

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Alpesh Amin ◽  
W. Richey Neuman ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
Jay Lin
Keyword(s):  
Venous Thromboembolism ◽  
Renal Disease ◽  
Age Groups ◽  
Disease Status ◽  
The United States ◽  
Hospitalized Patients ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medically Ill Patients

The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis patterns and risk for VTE events during hospitalization and in the outpatient continuum of care among patients hospitalized for acute illnesses in the United States with stratification by different age groups and renal disease status. Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n = 10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n = 4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study cohorts, the majority of patients received no VTE prophylaxis regardless of age or baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6 months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75 years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless of age and renal disease status.

scholarly journals Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

2019 ◽  
Vol 6 (1) ◽  
pp. 83-88
Author(s):  
Ujjawal Paudel ◽  
Prashant Raj Bhatt ◽  
Choodamani Nepal
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Acute Infection ◽  
Tertiary Care ◽  
Medical Ward ◽  
Assessment Model ◽  
Medical Patients ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding

 Introductions: Studies have shown inadequate use of prophylaxis for venous thromboembolism (VTE) in hospital admitted medical patients. This study aims to evaluate the use of VTE prophylaxis in admitted medical patients in a tertiary care teaching hospital. Methods: This was a cross sectional observational study for three weeks from 19 March to 8 April 2017 in patients admitted in the medical ward of Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Patient charts were reviewed for appropriate VTE prophylaxis as per modified Padua risk Assessment model. Risks of VTE, presence of bleeding risks, demographics (age, BMI), hospital stay were descriptively analysed. Results: Out of 122 patients, 81 (66.4%) were at risk of VTE. Among 81 at risk, 69 were eligible for VTE pharmacoprophylaxis with no risk of bleeding only 29 (42%) received pharmacoprophylaxis and 12 eligible for prophylaxis but with the risk of bleeding did not receive any prophylaxis. Reduced mobility was the most common indication of thromboprophylaxis in 79 (64%), followed by acute infection 50 (41%). Conclusions: There was suboptimal use of thromboprophylaxis in hospital admitted medical patients at risk of venous thromboembolism, VTE.

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

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.

scholarly journals Safety and Efficacy of Enoxaparin Compared With Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Hemodialysis Patients

2017 ◽  
Vol 52 (9) ◽  
pp. 623-627 ◽  
Author(s):  
Melissa S. Green ◽  
Katie B. Tellor ◽  
Amanda R. Buckallew
Keyword(s):  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Bleeding Complications ◽  
Secondary Outcome ◽  
Renal Elimination ◽  
Minor Bleeding ◽  
Safety And Efficacy ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medically Ill Patients

Background: Enoxaparin, a low-molecular-weight heparin approved for prophylaxis in patients at risk for venous thromboembolism (VTE), offers several advantages compared with unfractionated heparin (UFH). Enoxaparin is primarily excreted through renal elimination and is currently not recommended in patients receiving hemodialysis (HD) due to potential increased bleeding complications. To date, there are limited safety and efficacy data supporting the use of enoxaparin in this patient population for VTE prophylaxis. Objective: The aim of this study was to compare the safety and efficacy of enoxaparin with UFH for deep venous thromboembolism (DVT) prophylaxis in medically ill HD patients. Methods and Results: This retrospective cohort study examined medically ill patients who received HD and were concomitantly prescribed enoxaparin or UFH for at least 2 consecutive days for VTE prophylaxis. A total of 225 patients (150 received UFH and 75 received enoxaparin) were evaluated in chronological order. The primary outcome was a composite of major, clinically relevant nonmajor, and minor bleeding based on International Society on Thrombosis and Haemostasis bleeding definitions. The secondary outcome was the occurrence of a confirmed thrombotic event. Baseline characteristics were similar between the cohorts. One patient in each cohort had a documented bleed (UFH = 0.7%, enoxaparin = 1.3%, P > .05) during the admission assessed; however, neither bleed was related to the prophylactic agent utilized. No patients developed a VTE during the index hospitalization. Conclusions: This study demonstrates that enoxaparin may be as safe and effective as UFH for VTE prophylaxis in medically ill patients receiving HD.

Prevention of Venous Thromboembolism in Medically Ill Patients: Global and Individual Adherences Adjust to Risk Groups

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4061-4061
Author(s):  
Beatriz Grand ◽  
Jorge Orosco ◽  
Roberto Cacchione ◽  
Patricio Duarte ◽  
Dardo Riveros
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Group ◽  
Risk Groups ◽  
Individual Risk ◽  
Medical Patients ◽  
Medically Ill ◽  
Mechanical Methods ◽  
Correct Application ◽  
Medically Ill Patients

Abstract Introduction: Venous thromboembolism (VTE) is an important problem for medical patients. In spite of the existence of evidence-based guidelines for prevention of VTE, prophylaxis for venous thromboembolism is underutilized. Objective: To assess the global and individual adherences (adjust to risk groups) to venous thromboembolism prophylaxis guidelines (VTEPG) in medical ill patients. Desing: Prospective observational study. Setting: The 50-bed medical floors of a university hospital. Material and Methods: Patients: All consecutively medically ill patients (pt) admitted during a 6-month period (n: 452). VTEPG: the guide divided medical patients in risk groups (G); G1: No need of VTEP (35 pt); G2: myocardial infarction (9 pt); G3: Stroke (21 pt); G4: high risk with thrombophilia, previous VTE, cancer (113pt); G5: respiratory and congestive heart failure, pulmonary infection (137 pt); G6: trauma (5 pt); G7: not included in previous groups, required an individual evaluation to asses VTE risk (112pt). Prophylaxis methods included: low dose unfractionated heparin (UFH) or low molecular weight heparin (enoxaparin 40 mg/d) and mechanical methods. Main outcome measurements: 1- Global: correct application of the guide (defined by a coincidence between the prophylaxis received and the recommendation); 2-Adjust to risk group. Results: Global adherence: Correct application of the guide was noted in 252 pts (56%); Adjust to risk group: GR1:71%; GR2:44%; GR3:62%; GR4:76%; GR5:55%; GR6:60% and GR7:26%. Conclusion: In our experience in medical patients global adherence to guides was 56%, the best adherence was observed in high risk groups 76% and the lowest 26% in those patients that need an individual risk assessment. This study and follow up permitted us to detect inaccurate prophylaxis uses and take corrective measures.

Thromboprophylaxis in medically ill patients at risk for venous thromboembolism

2006 ◽  
Vol 63 (20_Supplement_6) ◽  
pp. S23-S29 ◽  
Author(s):  
Edward Burleigh ◽  
Cheng Wang ◽  
David Foster ◽  
Sivana Heller ◽  
Dennis Dunn ◽  
...  
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Medically Ill ◽  
Patients At Risk ◽  
Medically Ill Patients

scholarly journals Prevention of venous thromboembolism in hospitalized patients with chronic kidney disease

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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