scholarly journals Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines

2012 ◽  
Vol 3 (3) ◽  
pp. 193-207
Author(s):  
Luca Masotti ◽  
Roberto Cappelli ◽  
Grazia Panigada ◽  
Giancarlo Landini ◽  
Mario Di Napoli
Keyword(s):  
Venous Thromboembolism ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Intermittent Pneumatic Compression ◽  
Medical Patients ◽  
Compression Stockings ◽  
Mechanical Prophylaxis ◽  
Mortality And Morbidity ◽  
Vte Prophylaxis ◽  
Unfractioned Heparin

Venous thromboembolism (VTE) represents one of the leading causes of mortality and morbidity in ill medical patients. Avoiding VTE is therefore of utmost importance in clinical practice. VTE prophylaxis can be assured by pharmacological strategies, such as heparinoids, unfractioned heparin, low molecular weight heparins, fondaparinux or oral anticoagulants and, when these are contraindicated, by mechanical measures, such as graduated compression stockings (GCS) and/ or intermittent pneumatic compression (ICP). However, due to the lack of solid literature evidence, VTE mechanical prophylaxis is not standardized in hospitalized ill medical patients. Much recently, findings from randomized clinical trials on VTE prophylaxis in ill medical patients, such as CLOTS I in patients with stroke and LIFENOX in patients with other kind of medical diseases, seem to increase doubts and reduce certainness in this context and recommendations from guidelines don’t help in reducing confusion. Therefore the aim of this review is to focus on mechanical prophylaxis of VTE in hospitalized ill medical patients.http://dx.doi.org/10.7175/rhc.v3i3.202

scholarly journals Mechanical prophylaxis of venous thromboembolism in ill hospitalized medical patients: evidence and guidelines

2012 ◽  
Vol 3 (3) ◽  
pp. 193
Author(s):  
Luca Masotti ◽  
Roberto Cappelli ◽  
Grazia Panigada ◽  
Giancarlo Landini ◽  
Mario Di Napoli
Keyword(s):  
Venous Thromboembolism ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Intermittent Pneumatic Compression ◽  
Medical Patients ◽  
Compression Stockings ◽  
Mechanical Prophylaxis ◽  
Mortality And Morbidity ◽  
Vte Prophylaxis ◽  
Unfractioned Heparin

Venous thromboembolism (VTE) represents one of the leading causes of mortality and morbidity in ill medical patients. Avoiding VTE is therefore of utmost importance in clinical practice. VTE prophylaxis can be assured by pharmacological strategies, such as heparinoids, unfractioned heparin, low molecular weight heparins, fondaparinux or oral anticoagulants and, when these are contraindicated, by mechanical measures, such as graduated compression stockings (GCS) and/ or intermittent pneumatic compression (ICP). However, due to the lack of solid literature evidence, VTE mechanical prophylaxis is not standardized in hospitalized ill medical patients. Much recently, findings from randomized clinical trials on VTE prophylaxis in ill medical patients, such as CLOTS I in patients with stroke and LIFENOX in patients with other kind of medical diseases, seem to increase doubts and reduce certainness in this context and recommendations from guidelines don’t help in reducing confusion. Therefore the aim of this review is to focus on mechanical prophylaxis of VTE in hospitalized ill medical patients.http://dx.doi.org/10.7175/rhc.v3i3.202

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.

scholarly journals The current place of direct oral anticoagulants in the prevention/treatment of venous thromboembolism

2020 ◽  
Vol 70 (5) ◽  
pp. 284-296
Author(s):  
Maja Tomić
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Secondary Prevention ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Comparable Efficacy ◽  
Thrombin Inhibitor ◽  
Medical Patients ◽  
Vte Prophylaxis

Venous thromboembolism (VTE; includes deep venous thrombosis, DVT, and pulmonary embolism, PE) represents the third most common acute cardiovascular syndrome. Contemporary VTE management comprises primary prevention in high-risk patients, treatment of established VTE, and prevention of its recurrence (secondary prevention). Anticoagulants are the basis of VTE pharmacological prophylaxis and treatment. For several decades, parenteral (heparin and low-molecular-weight heparins, LMWHs) and oral anticoagulants (vitamin K antagonists, VKAs) have been the cornerstone of VTE prevention/treatment. The introduction of direct oral anticoagulants (DOACs: thrombin inhibitor dabigatran and Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban) markedly improved the management of VTE by overcoming many disadvantages of conventional anticoagulants. For primary VTE prevention in patients after total hip/knee arthroplasty, rivaroxaban, apixaban, and dabigatran are preferred over LMWHs, due to comparable efficacy and safety, but favourable acceptability (avoided everyday injections). In other high-risk populations (other surgical patients, acutely ill medical patients), LMWHs are still the recommended option. Betrixaban is currently the only DOAC approved for VTE prophylaxis in medically ill patients during and after hospitalization. For acute VTE treatment and secondary prevention, DOACs (rivaroxaban, apixaban, edoxaban, and dabigatran) are recommended as the first-line therapy in the general population. DOACs proved to be similarly effective but safer than VKAs. In some specific populations, DOACs also seem to be advantageous over conventional treatment (patients with renal impairment, elderly, long-term secondary prevention in cancer patients). Currently, there is no data from randomized head-to-head comparative studies between the DOAC classes or representatives so the choice is made mainly according to patient characteristics and pharmacokinetic properties of the drug.

Venous thromboembolism in patients with brain tumors

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 12528-12528
Author(s):  
M. S. Dhami ◽  
D. Goss ◽  
R. Dhami
Keyword(s):  
Venous Thromboembolism ◽  
Brain Tumors ◽  
Malignant Gliomas ◽  
Intermittent Pneumatic Compression ◽  
Consensus Conference ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Frequency Of Use ◽  
Superficial Vein Thrombosis

12528 Venous Thromboembolism (VTE) is common in patients undergoing treatment for brain tumors. American College of Chest Physicians (ACCP) 2004 consensus conference recommends routine use of intermittent pneumatic compression devices (IPC), unfractionated heparin (UH) or low molecular weight heparin (LMWH) for VTE prophylaxis in these patients. There, however, continues to be a reluctance on using pharmacologic VTE prophylaxis in these patients. The goal of our study was to determine the incidence of VTE in patients with brain tumors treated at a community hospital and the frequency of use of thromboprophylaxis in these patients. Both electronic and paper charts of all patients treated for brain tumors between 1997 and 2003 were reviewed. Follow up data was obtained by contacting physicians caring for these patients. Forty two patients were identified (Anaplastic astrocytoma 10; Glioblastoma multiforme 16; Meningioma 15; oligodendroglioma 1). Twelve patients were treated with various adjuvant chemotherapy regimens. Only 16 patients (38%) received any form of VTE prophylaxis. UH (12) or LMWH (2) were used with or without IPCs or graduated compression stockings. There were eight episodes of symptomatic VTE among 42 patients (19%). These include 6 episodes of deep vein thrombosis (DVT) and two cases of superficial vein thrombosis. Three patients with DVT also had symptomatic pulmonary embolus (PE). All episodes VTE were seen in patients with malignant gliomas yielding a 29% incidence of VTE in patients with malignant gliomas. None of the 15 patients with meningioma had symptomatic VTE. All but one episode of VTE were associated with administration of systemic chemotherapy. Half of these episodes occured more than six weeks after surgical debulking. We conclude that incidence of VTE with malignant brain tumors is high (29%) and the administration of chemotherpy increases this risk. There continues to be underutilization of VTE prophylaxis in these patients at very high risk of VTE. Efforts should be directed at improving the understanding of type and duration of appropiate VTE prophylaxis in patients with brain tumors. No significant financial relationships to disclose.

scholarly journals Thromboembolism prophylaxis in orthopaedics: an update

2018 ◽  
Vol 3 (4) ◽  
pp. 136-148 ◽  
Author(s):  
Dimitrios A. Flevas ◽  
Panayiotis D. Megaloikonomos ◽  
Leonidas Dimopoulos ◽  
Evanthia Mitsiokapa ◽  
Panayiotis Koulouvaris ◽  
...  
Keyword(s):  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Intermittent Pneumatic Compression ◽  
Hospital Death ◽  
Compression Stockings ◽  
Thromboembolism Prophylaxis ◽  
Leg Injuries ◽  
Vte Prophylaxis ◽  
Orthopaedic Patients

Venous thromboembolism (VTE) is a serious complication during and after hospitalization, yet is a preventable cause of in-hospital death. Without VTE prophylaxis, the overall VTE incidence in medical and general surgery hospitalized patients is in the range of 10% to 40%, while it ranges up to 40% to 60% in major orthopaedic surgery. With routine VTE prophylaxis, fatal pulmonary embolism is uncommon in orthopaedic patients and the rates of symptomatic VTE within three months are in the range of 1.3% to 10%. VTE prophylaxis methods are divided into mechanical and pharmacological. The former include mobilization, graduated compression stockings, intermittent pneumatic compression device and venous foot pumps; the latter include aspirin, unfractionated heparin, low molecular weight heparin (LMWH), adjusted dose vitamin K antagonists, synthetic pentasaccharid factor Xa inhibitor (fondaparinux) and newer oral anticoagulants. LMWH seems to be more efficient overall compared with the other available agents. We remain sceptical about the use of aspirin as a sole method of prophylaxis in total hip and knee replacement and hip fracture surgery, while controversy still exists regarding the use of VTE prophylaxis in knee arthroscopy, lower leg injuries and upper extremity surgery.Cite this article: EFORT Open Rev 2018;3:130-142. DOI: 10.1302/2058-5241.3.170018

scholarly journals A Review of Current and Future Antithrombotic Strategies in Surgical Patients—Leaving the Graduated Compression Stockings Behind?

2021 ◽  
Vol 10 (19) ◽  
pp. 4294
Author(s):  
Amulya Khatri ◽  
Matthew Machin ◽  
Aditya Vijay ◽  
Safa Salim ◽  
Joseph Shalhoub ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Intermittent Pneumatic Compression ◽  
Surgical Patients ◽  
Future Research ◽  
Compression Stockings ◽  
High Quality ◽  
Mechanical Prophylaxis ◽  
Risk Assessment Models ◽  
Risk Patients

Venous thromboembolism (VTE) remains an important consideration within surgery, with recent evidence looking to refine clinical guidance. This review provides a contemporary update of existing clinical evidence for antithrombotic regimens for surgical patients, providing future directions for prophylaxis regimens and research. For moderate to high VTE risk patients, existing evidence supports the use of heparins for prophylaxis. Direct oral anticoagulants (DOACs) have been validated within orthopaedic surgery, although there remain few completed randomised controlled trials in other surgical specialties. Recent trials have also cast doubt on the efficacy of mechanical prophylaxis, especially when adjuvant to pharmacological prophylaxis. Despite the ongoing uncertainty in higher VTE risk patients, there remains a lack of evidence for mechanical prophylaxis in low VTE risk patients, with a recent systematic search failing to identify high-quality evidence. Future research on rigorously developed and validated risk assessment models will allow the better stratification of patients for clinical and academic use. Mechanical prophylaxis’ role in modern practice remains uncertain, requiring high-quality trials to investigate select populations in which it may hold benefit and to explore whether intermittent pneumatic compression is more effective. The validation of DOACs and aspirin in wider specialties may permit pharmacological thromboprophylactic regimens that are easier to administer.

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.

PS-100 Venous thromboembolism (VTE) prophylaxis for hospitalised medical patients (HMP) with low molecular weight heparin (LMWH)

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A176.1-A176
Author(s):  
FI Ferreira Tátá ◽  
MA Pires Rebelo ◽  
ML Grenho Pereira ◽  
NM Ribeiro Landeira ◽  
SM Dias Fanica ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Vte Prophylaxis

scholarly journals Systematic review on the benefit of graduated compression stockings in the prevention of venous thromboembolism in low-risk surgical patients

2020 ◽  
pp. 026835552095859
Author(s):  
M Machin ◽  
HC Younan ◽  
S Smith ◽  
Safa Salim ◽  
AH Davies ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Included Study ◽  
Low Risk ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Eligible Article ◽  
Graduated Compression Stockings

Objectives The aim of this systematic review is to assess the performance of graduated compression stockings (GCS) in comparison to no venous thromboembolism (VTE) prophylaxis in the prevention of hospital-acquired thrombosis in low-risk surgical patients undergoing short-stay procedures. Methods Aligning with PRISMA guidelines, online databases MEDLINE and EMBASE, Cochrane Library® and trial registries were searched. Eligible articles reported the VTE rate in low-risk surgical patients either receiving GCS or no VTE prophylaxis. Results Narrative synthesis was performed on a single eligible article. The included study arm consisted of participants undergoing knee arthroscopy with the use of GCS alone reporting a total of 29 VTE events (4.4%), 16 of which were asymptomatic DVTs (2.4%). Conclusion There is a complete lack of evidence to support the use of GCS in the prevention of HAT for low-risk surgical patients. An adequately powered trial is required to provide level-IA evidence to support this practice.

scholarly journals Reduced risk of venous thromboembolism with the use of intermittent pneumatic compression after craniotomy: a randomized controlled prospective study

2019 ◽  
Vol 130 (2) ◽  
pp. 622-628 ◽  
Author(s):  
Julian Prell ◽  
Grit Schenk ◽  
Bettina-Maria Taute ◽  
Christian Scheller ◽  
Christian Marquart ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Prospective Study ◽  
Controlled Trial ◽  
Intermittent Pneumatic Compression ◽  
Control Group ◽  
Compression Stockings ◽  
Clinical Trial Registration ◽  
Randomized Controlled ◽  
Duration Of Surgery

OBJECTIVEThe term “venous thromboembolism” (VTE) subsumes deep venous thrombosis (DVT) and pulmonary embolism. The incidence of DVT after craniotomy was reported to be as high as 50%. Even clinically silent DVT may lead to potentially fatal pulmonary embolism. The risk of VTE is correlated with duration of surgery, and it appears likely that it develops during surgery. The present study aimed to evaluate intraoperative use of intermittent pneumatic compression (IPC) of the lower extremity for prevention of VTE in patients undergoing craniotomy.METHODSA total of 108 patients undergoing elective craniotomy for intracranial pathology were included in a single-center controlled randomized prospective study. In the control group, conventional compression stockings were worn during surgery. In the treatment group, IPC of the calves was used in addition. The presence of DVT was evaluated by Doppler sonography pre- and postoperatively.RESULTSIntraoperative use of IPC led to a significant reduction of VTE (p = 0.029). In logistic regression analysis, the risk of VTE was approximately quartered by the use of IPC. Duration of surgery was confirmed to be correlated with VTE incidence (p < 0.01); every hour of surgery increased the risk by a factor of 1.56.CONCLUSIONSIntraoperative use of IPC significantly lowers the incidence of potentially fatal VTE in patients undergoing craniotomy. The method is easy to use and carries no additional risks.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class I.Clinical trial registration no.: DRKS00011783 (https://www.drks.de)

Sign in / Sign up

Export Citation Format

Share Document