Primary antithrombotic prevention of venous thrombosis in internal medicine

Czech version

Authors: J. Kvasnička
Authors‘ workplace: Trombotické centrum VFN, Praha, přednosta prof. MUDr. Jan Kvasnička, DrSc.
Published in: Vnitř Lék 2005; 91(7 a 8): 781-789
Category: 128th Internal Medicine Day - 21rd Vanysek's Day Brno 2005

Overview

Two large clinical studies MEDENOX and PREVENT in acute ill medical patients show a consistent 50% reduction in venous thromboembolism (VTE) with low molecular heparin (LMWH) prophylaxis. Therefore, the prophylaxis of VTE with low dose of unfractioned heparin (grade 1 A) or LMWH (grade 1 A) is now recommended to the medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed (for more than 72 hours) and have one or more additional risk factors (infection, prior VTE, cancer, thrombophilia etc). But this recommendation is not widely practiced, partly due to the heterogenity of this group. Current prophylaxis for VTE in high-risk situations, such as sepsis, can be also suboptimal. Our results show that 54.7% of septic patients hospitalized in an intensive care unit and using prophylactic doses of LMWH had an inhibition of F Xa under 0.2 IU/mL, therefore they were underanticoagulated too. The article discusses the importance of laboratory monitoring of LMWH in acute ill patients with presumptive continuous progression of thrombin generation, e.g. in sepsis.

Key words:
heparin – LMWH – prophylaxis – venous thrombosis – internal medicine – laboratory monitoring

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