Therapeutic Update on the Prevention and Treatment of Venous Thromboembolism

2004 ◽  
Vol 17 (5) ◽  
pp. 289-307 ◽  
Author(s):  
Mike McGuire ◽  
Paul P. Dobesh
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight ◽  
Outpatient Basis ◽  
Medical Patients ◽  
Common Condition ◽  
Low Molecular Weight Heparins ◽  
The Past ◽  
Prevention And Treatment

Venous thromboembolism (VTE) is a common condition that increases in incidence with age and risk factors. Therapies for VTE are aimed at either preventing the disease in high-risk individuals or treating patients who have developed VTE. Assessing risk and aggressively using the recommended therapies is primacy in preventing VTE in surgical and medical patients. Risk of VTE in medical patients has become more defined in recent years, and prophylaxis in this group can prevent scores of iatrogenic VTE. Treatment of VTE has evolved in the past decade from a condition that required hospitalization for 5 to 7 days to a disease state that can be conveniently and safely treated on an outpatient basis, largely due to the advent of low-molecular-weight heparins and patient self-directed treatment.

The Role of Low Molecular Weight Heparins for Venous Thromboembolism Prevention in Medical Patients—What Is New in 2019?

2019 ◽  
Vol 39 (01) ◽  
pp. 062-066 ◽  
Author(s):  
Sylvia Haas
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Randomized Clinical Trials ◽  
Scientific Evidence ◽  
Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Low Molecular Weight Heparins ◽  
Venous Thromboembolism Prevention ◽  
Extended Duration

AbstractLow molecular weight heparins and fondaparinux have been the cornerstones for prevention of venous thromboembolism (VTE) in acutely ill medical patients for almost two decades. Guidelines recommend the use of these parenteral anticoagulants for 6 to 14 days but advise against extended-duration thromboprophylaxis after hospital discharge because no compelling scientific evidence has been provided for pharmacological prophylaxis beyond hospital stay. Five large randomized clinical trials, one with low molecular weight heparin and four with nonvitamin K antagonist oral anticoagulants, have failed to show significant clinically relevant benefit in this indication. Obviously, the development of VTE is more complex in medical patients than in patients undergoing major surgical procedures. Thus, it can be expected that guideline recommendations for VTE prevention with low molecular weight heparins or fondaparinux in medical patients will remain unchanged in 2019.

Thrombosis prophylaxis prior to surgery

2003 ◽  
Vol 18 (3) ◽  
pp. 106-109
Author(s):  
D Bergqvist
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Review Article ◽  
Thrombosis Prophylaxis ◽  
Low Molecular Weight ◽  
Low Molecular Weight Heparins ◽  
Thrombin Inhibition ◽  
New Methods

This review article provides an update on risk factors of venous thromboembolism and methods for preventing its occurrence following surgery. A summary of the prophylactic methods that are currently available is provided, with particular attention given to low molecular weight heparins, which are the most popular. The new methods of Xa inhibition and oral thrombin inhibition are also mentioned. Finally, the most appropriate times to start prophylaxis and the necessary duration are discussed, along with some of the risks of prophylaxis.

Venous Thromboembolism Prevention with LMWHs in Medical and Orthopedic Surgery Patients

2003 ◽  
Vol 37 (3) ◽  
pp. 402-411 ◽  
Author(s):  
Steven B Deitelzweig ◽  
Gordon J Vanscoy ◽  
Cynthia S Niccolai ◽  
Thomas L Rihn
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Orthopedic Surgery ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Efficacy And Safety ◽  
Consensus Guidelines ◽  
Medline Search ◽  
Vte Prophylaxis

OBJECTIVE: To discuss the role of low-molecular-weight heparins (LMWHs) in the prevention of venous thromboembolism (VTE) in medical and orthopedic surgery patients. VTE prophylaxis trials in these practice settings establishing the current use of LMWHs marketed in the US are included. An overview is also provided of VTE incidence, risk factors, and prophylaxis consensus guidelines. DATA SOURCES AND STUDY SELECTION: Clinical trials, review articles, and meta-analyses for Food and Drug Administration–approved LMWHs were identified from a MEDLINE search (1980–March 2002). Search terms included dalteparin, enoxaparin, internal medicine, low-molecular-weight heparin, orthopedic surgery, risk factors, tinzaparin, and venous thromboembolism. DATA SYNTHESIS: Consensus guidelines are useful as an initial guide to appropriate VTE prophylaxis; however, a review of the primary literature is needed to identify optimal agents, regimens, or interventions. LMWHs have demonstrated sound efficacy in VTE prevention; however, the quantity and quality of literature are not always comparable for the available agents. CONCLUSIONS: Enoxaparin has demonstrated efficacy and safety in VTE prevention in medical patients, whereas information is limited or lacking for dalteparin and tinzaparin. Total hip replacement (THR) trials have been conducted with all US-marketed LMWHs and have demonstrated the efficacy and safety of each agent. Trials specifically establishing the efficacy of an LMWH in total knee replacement surgery (TKR) have been published for enoxaparin. One combination THR and TKR trial has been published for tinzaparin. These trial outcomes have positioned the LMWHs as key alternatives to adjusted-dose warfarin for VTE prophylaxis in orthopedic surgery. Inherent differences between LMWHs prevent the extrapolation of clinical outcomes from 1 trial to another.

Prevention of Venous Thromboembolism in Internal Medicine with Unfractionated or Low-molecular-weight Heparins: A Meta-analysis of Randomised Clinical Trials

2000 ◽  
Vol 83 (01) ◽  
pp. 14-19 ◽  
Author(s):  
Silvy Laporte-Simitsidis ◽  
Bernard Tardy ◽  
Michel Cucherat ◽  
Andréa Buchmüller ◽  
Daphné Juillard-Delsart ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Meta Analysis ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Randomised Trials ◽  
Low Molecular Weight Heparins ◽  
Significant Difference ◽  
Venous Thromboembolic

SummaryThe prevention of venous thromboembolic disease is less studied in medical patients than in surgery.We performed a meta-analysis of randomised trials studying prophylactic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in internal medicine, excluding acute myocardial infarction or ischaemic stroke. Deepvein thrombosis (DVT) systematically detected at the end of the treatment period, clinical pulmonary embolism (PE), death and major bleeding were recorded.Seven trials comparing a prophylactic heparin treatment to a control (15,095 patients) were selected. A significant decrease in DVT and in clinical PE were observed with heparins as compared to control (risk reductions = 56% and 58% respectively, p <0.001 in both cases), without significant difference in the incidence of major bleedings or deaths. Nine trials comparing LMWH to UFH (4,669 patients) were also included. No significant effect was observed on either DVT, clinical PE or mortality. However LMWH reduced by 52% the risk of major haemorrhage (p = 0.049).This meta-analysis, based on the pooling of data available for several heparins, shows that heparins are beneficial in the prevention of venous thromboembolism in internal medicine.

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