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The Prophylaxis against Venous Thromboembolic Complications in Internal Medicine - the Gap between Theory and Practice


Authors: J. Hirmerová
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN, Plzeň, přednosta doc. MUDr. Jan Filipovský, CSc.
Published in: Vnitř Lék 2006; 52(4): 379-388
Category: Review

Overview

Venous thromboembolism is an important cause of morbidity and mortality in internal medicine but antithrombotic prophylaxis is not being sufficiently used in comparison with surgical settings. In medical patients there are usually multiple risk factors, often with cumulative effect and the comprehensive risk assessment is complicated. The most important agents for pharmacological thromboprophylaxis are heparins - unfractionated and low-molecular-weight. The metaanalysis of randomised trials comparing unfractionated or low-molecular-weight heparin against control (placebo or aspirin) in medical patients has confirmed a significant risk reduction for deep vein thrombosis (56 %) as well as pulmonary embolism (58 %). Low-molecular-weight heparin is as effective as unfractionated heparin in reducing mortality as well as venous thromboembolism but has the advantage of significantly fewer bleeding complications. A novel synthetic pentasaccharide antithrombotic agent fondaparinux has been successfully proved in thromboprophylaxis in medical patients too. In most trials the duration of pharmacological prophylaxis was up to 2 weeks, the possible benefit of extended prophylaxis has not been clarified yet. Specific groups are intensive care patients; the elderly for their high thromboembolic as well as bleeding risk and significant comorbidity; the patients with acute ischaemic stroke who have very high thromboembolic risk but there are concerns about the risk of haemorrhagic transformation of stroke. The economic studies have shown that low-molecular-weight heparin in prophylactic doses in acutely ill medical patients is cost-effective strategy.

Key words:
deep vein thrombosis - pulmonary embolism - prophylaxis - heparins


Sources

1. Bobek K, Čepelák V. Prevence tromboembolické nemoci. In: Tromboembolická nemoc žilního původu. Praha: Státní zdravotnické nakladatelství 1959.

2. Kakkar AK, Davidson BL, Haas SK. Compliance with recommended prophylaxis for venous thromboembolism: improving the use and rate of uptake of clinical practical guidelines. J Thromb Haemost 2004; 2: 221-227.

3. Geerts WH, Heit JA, Pineo GF et al. Prevention of venous thromboembolism. The Sixth Consensus Conference of Antithrombotic Therapy. Chest 2001; 119: 132S-175S.

4. Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82: 203-205.

5. Baglin TP, White K, Charles A. Fatal pulmonary embolism in hospitalized medical patients. J Clin Pathol 1997; 50: 609-610.

6. Goldhaber SZ, Savage DD, Garrison RJ et al. Risk factors for pulmonary embolism. The Framingham Study. Am J Med 1983; 74: 1023-1028.

7. Collins R, Scrimgeour A, Yusuf A et al. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomised trials in general, orthopedic and urologic surgery. N Engl J Med 1988; 318: 1162-1173.

8. The SCATI (Studio sulla Calciparina nell´Angina e nella Trombosi Ventricolare nell´Infarto) Group. Randomised controlled trial of subcutaneous calcium-heparin in acute myocardial infarction. Lancet 1989; 2: 182-186.

9. Sandercock PAG, van den Belt AGM, Lindley RI et al. Antithrombotic therapy in acute ischaemic stroke: an overview of the completed randomised trials. J Neurol Neurosurg Psychiatry 1993; 56: 17-25.

10. Belch JJ, Lowe GD, Ward AG et al. Prevention of deep vein thrombosis in medical patients by low-dose heparin. Scott Med J 1981; 26: 115-117.

11. Cade JF. High risk of the critically ill for venous thromboembolism. Crit Care Med 1982; 10: 448-450.

12. Samama MM, Cohen AT, Darmon JY et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely medical ill patients: Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 1999; 341: 793-800.

13. Hirsch DR, Ingenito EP, Goldhaber SZ. Prevalence of deep venous thrombosis among patients in medical intensive care. JAMA 1995; 274: 335-337.

14. Zakai NA, Wright J, Cushman M. Risk factors for venous thrombosis in medical inpatients: validation of a thrombosis risk score. J Thromb Haemost 2004; 2: 2156-2161.

15. Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107: I9-I16.

16. Cohen AT, Alikhan R, Arcelus JI et al. Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 2005; 94: 750-759.

17. Spyropoulos AC. Emerging strategies in the prevention of venous thromboembolism in hospitalized medical patients. Chest 2005; 128: 958-969.

18. Turpie AGG, Norris TN. Thromboprophylaxis in medical patients: the role of low-molecular-weight heparin. Thromb Haemost 2004; 92: 3-12.

19. Nicolaides AN, Breddin HK, Fareed J et al. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol 2001; 20: 1-37.

20. Warlow C, Ogston D, Douglas AS. Deep venous thrombosis of the legs after stroke. Br Med J 1976; 1: 1178-1183.

21. Gensini GF, Prisco D, Falciani M et al. Identification of candidates for prevention of venous thromboembolism. Semin Thromb Hemost 1997; 23: 55-67.

22. Alikhan R, Cohen AT, Combe S et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness. Arch Intern Med 2004; 164: 963-968.

23. Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: a retrospective case-control study. J Clin Epidemiol 2001; 54: 810-816.

24. Samama MM. Epidemiology of risk factors of deep venous thrombosis of the lower limbs in community practice: the SIRIUS study. Thromb Haemost 1993; 69: 763.

25. Lip GY, Chin BS, Blann AD. Cancer and the prothrombotic state. Lancet Oncol 2002; 3: 27-34.

26. DeMaria AN. Relative risk of cardiovascular events in patients with rheumatoid artritis. Am J Cardiol 2002; 89: 33D-38D.

27. Silverstein MD, Heit JA, Mohr DN et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism. Arch Intern Med 1998; 158: 585-593.

28. White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107(Suppl): I4-I8.

29. Gibbs NM. Venous thrombosis of the lower limbs with particular reference to bedrest. Br J Surg 1957; 45: 209-236.

30. Warlow C, Ogston D, Douglas AS. Venous thrombosis following strokes. Lancet 1972; 1: 1305-1306.

31. Heit JA, Silverstein MD, Mohr DN et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160: 809-815.

32. Lidegaard O, Edstrom B, Kreiner S. Oral contraceptives and venous thromboembolism: a five-year national case-control study. Contraception 2002; 65: 187-196.

33. Daly E, Vessey MP, Hawkins MM et al. Risk of venous thromboembolism in users of hormone replacement therapy. Lancet 1996; 348: 977-980.

34. Goldhaber SZ, Turpie AGG. Prevention of venous thromboembolism among hospitalized medical patients. Circulation 2005; 111(Suppl): e1-e3.

35. Geerts WH, Pineo GF, Heit JA et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic Therapy. Chest 2004; 126(Suppl): 338S-400S.

36. Verstraete M. Fortnightly review: Prophylaxis of venous thromboembolism. BMJ 1997; 314: 123-131.

37. Imberti D, Prisco D. Venous thromboembolism prophylaxis in medical patients: future perspectives. Thromb Res 2005; 116: 365-375.

38. Bern MM, Bothe A Jr, Bistrian B et al. Prophylaxis against central vein thrombosis with low-dose warfarin. Surgery 1986; 99: 216-221.

39. Bern MM, Lokich JJ, Wallach SR et al. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Intern Med 1990; 112: 423-428.

40. Bona RD, Sivjee KY, Hickey AD et al. The efficacy and safety of oral anticoagulation in patients with cancer. Thromb Haemost.1995; 74: 1055-1058.

41. Gallus AS, Hirsch J, Tuttle RJ et al. Small subcutaneous doses of heparin in prevention of venous thrombosis. N Engl J Med 1973; 288: 545-551.

42. Ibarra-Pérez C, Lau-Cortés E, Colmenero-Zubiate S et al. Prevalence and prevention of deep vein thrombosis of the lower extremities in high-risk pulmonary patients. Angiology 1988; 39: 505-513.

43. Halkin H, Goldberg J, Modan M et al. Reduction of mortality in general medical inpatients by low-dose heparin prophylaxis. Ann Intern Med 1982; 96: 561-565.

44. Gårdlund B Randomised, controlled trial of low-dose heparin for prevention of fatal pulmonary embolism in patients with infectious diseases. The Heparin Prophylaxis Study Group. Lancet 1996; 347: 1357-1361.

45. Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients: results of meta-analysis. Ann Surg 1988; 208: 227-240.

46. Bergmann JF, Caulin C. Heparin prophylaxis in bedridden patients. Lancet 1996; 348: 205-206.

47. Dahan R, Houlbert D, Caulin CE et al. Prevention of deep vein thrombosis in elderly medical in-patients by a low molecular weight heparin: a randomized double-blind trial. Haemostasis 1986; 16: 159-164.

48. Fraisse F, Holzapfel L, Couland JM et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France. Am J Respir Care Med 2000; 161: 1109-1114.

49. Leizorovitz A, Cohen AT, Turpie AGG et al. Randomized placebo controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110: 874-879.

50. Alikhan R, Cohen AT, Combe S et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis 2003; 14: 341-346.

51. Bergmann JF, Neuhart E. A multicenter randomized double-blind study of enoxaparin compared with unfractionated heparin in the prevention of venous thromboembolic disease in elderly in-patients bedridden for an acute medical illness. The Enoxaparin in Medicine Study Group. Thromb Haemost 1996; 76: 529-534.

52. Lechler E, Schramm W, Flosbach CW. The venous thrombotic risk in non-surgical patients: epidemiological data and efficacy/safety profile of a low-molecular-weight heparin (enoxaparin). The Prime Study Group. Haemostasis 1996; 26(Suppl 2): 49-56.

53. Kleber FX, Witt C, Vogel G et al. Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J 2003; 145: 614-621.

54. Harenberg J, Roebruck P, Heene DL. Subcutaneous low-molecular-weight heparin versus standard heparin and the prevention of thromboembolism in medical inpatients. The Heparin Study in Internal Medicine Group. Haemostasis 1996; 26: 127-139.

55. Mismetti P, Laporte-Simitsidis S, Tardy B et al. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thromb Haemost 2000; 28(Suppl. 3): 51-55.

56. Cohen AT, Gallus AS, Lassen MR et al. Fondaparinux vs. placebo for the prevention of venous thromboembolism in acutely ill medical patients (ARTEMIS). J Thromb Haemost 2003; 1(Suppl 1): P2046.

57. Bosson JL, Labarere J, Sevestre MA et al. Deep vein thrombosis in elderly patients hospitalized in subacute care facilities. Arch Intern Med 2003; 63: 2613-2618.

58. Gatt ME, Paltiel O, Bursztyn M. Is prolonged immobilization a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historical-cohort study. Thromb Haemost 2004; 91: 538-543.

59. Hull R, Tapson VF, Schellong S et al. The EXCLAIM Study: Extended Prophylaxis with Enoxaparin in Acutely Ill Medical Patients with Restricted Mobility (abstract). Blood 2003; 102(11): abstract 4208.

60. Di Minno G, Tufano A. Challenges in the prevention of venous thromboembolism in the elderly. J Thromb Haemost 2004; 2: 1292-1298.

61. Kamphuisen PW, Agnelli G, Sebastianelli M. Prevention of venous thromboembolism after acute ischemic stroke. J Thromb Haemost 2005; 3: 1187-1194.

62. Kelly J, Rudd A, Lewis RR et al. Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging. Stroke 2004; 35: 2320-2325.

63. McCarthy ST, Turner J. Low dose subcutaneous heparin in the prevention of deep-vein thrombosis and pulmonary emboli following acute stroke. Age Ageing 1986; 15: 84-88.

64. Pambianco G, Orchard T, Landau P. Deep vein thrombosis: prevention in stroke patients in stroke during rehabilitation. Arch Phys Med Rehabil 1995; 76: 324-330.

65. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet 1997; 349: 1569-1581.

66. Bath PM, Iddenden R, Bath FJ. Low-molecular-weight heparins and heparinoids in acute ischemic stroke: a meta-analysis of randomized controlled trials. Stroke 2000; 31: 1770-1778.

67. Diener HC, Ringelstein EB, Kummer R et al. Treatment of acute ischemic stroke with the low-molecular weight heparin certoparin: results of the TOPAS trial. Therapy of Patients with Acute Stroke (TOPAS) Investigators. Stroke 2001; 32: 22-29.

68. Hommel M for the FISS bis Investigators Group. Fraxiparine in ischaemic stroke study (FISS bis). Cerebrovasc Dis 1998; 279: 1265-1272.

69. Kvasnička J. Primární antitrombotická prevence žilní trombózy ve vnitřním lékařství. Vnitř Lék 2005; 51: 781-789.

70. Darze ES, Latado AL, Guimarães AG et al. Incidence and clinical predictors of pulmonary embolism in severe heart failure patients admitted to a coronary care unit. Chest 2005; 128: 2576-2580.

71. Tapson VF, Decousus H, Piovella F et al for the IMPROVE investigators. A multinational observational study in acutely ill medical patients of practices in prevention of venous thromboembolism: findings of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Blood 2003; 102: Abstract number 1154.

72. Rahim SA, Panju A, Menaka P et al. Venous thromboembolism prophylaxis in medical inpatients: a retrospective chart review. Thromb Res 2003; 111: 215-219.

73. Goldhaber SZ, Tapson VF. DVT FREE Steering Comittee. A prospective registry of 5451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259-262.

74. Spáčil J, Spáčilová J. Prevence žilní trombózy a plicní embolie na interním oddělení. Vnitř Lék 2005; 51: 518-522.

75. Pechevis M, Detournay B, Pribil C et al. Economic evaluation of enoxaparin vs. placebo for the prevention of venous thromboembolism in acutely ill medical patients. Value Health 2000; 3: 389-396.

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