Venous thromboembolism prophylaxis in internal medicine

Czech version

Authors: J. Malý ¹; J. Widimský ²; P. Ďulíček ¹
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ¹; Klinika kardiologie IKEM Praha, přednosta prof. MUDr. Josef Kautzner, CSc., FESC ²
Published in: Vnitř Lék 2009; 55(3): 190-195
Category: 15th Parizek's Days

Overview

Many of medical patients are significant risk of venous thromboembolism (VTE). VTE is the most common cause of preventable death in hospitalized patients. Prophylaxis is highly effective in reducing the risk of deep vein thrombosis and pulmonary embolism and should be used in most hospitalized patients. Various strategies improve adherence to evidence‑based guidelines on the use of prophylaxis, including a udit and feedback, and automatic reminders. The important clinical risk factors for PE (or venous thromboembolism VTE) include advanced age, general anaesthesia, prolonged immobility or paralysis, previous VTE, cancer, duration of surgery, orthopaedic surgery of lower limb leg, hip or pelvic fracture, major trauma, stroke, obesity, varicose veins, postoperative infection and heart failure. Medical patients ad bed rest or who are sick are in moderate risk of VTE and evidence based guidelines recommended thromboprophylaxis with low molecular weight heparin, or low dose of unfractionated heparin or Fondaparinux. For all situations both guidelines recommended against the use of aspirin for VTE prevention.

Key words:
venous thromboembolism prophylaxis – low molecular weight heparin – medical patients

Sources

1. Widimský J, Malý J. Doporučení pro diagnostiku a léčbu plicní embolie. Verze 2001. Cor Vasa 2001; 43: K158–K184.

2. Widimský J, Malý J et al. Akutní plicní embolie a žilní trombóza. 2. rozšířené a přepracované vydání. Praha: Triton 2005, 381 s.

3. Widimský J, Malý J, Eliáš P et al. Doporučení diagnostiky, léčby a prevence plicní embolie, verze 2007. Vnitř Lék 2008; 54 (Suppl 1): S25–S72.

4. Prandoni P, Samama MM. Risk stratification and venous thromboprophylaxis in hospitalized medical and cancer patients. Brit J Haemat 2008; 141: 587–597.

5. Malý J, Dulíček P, Penka M et al. Prevence žilní tromboembolické nemoci ve vnitřním lékařství a neurologii. Vnitřní Lék 2006; 52 (Suppl 1): 63–67.

6. Torbicki A, van Beek EJR, Charbonnier B et al. Guidelines on diagnosis and management of acute pulmonary embolism. Eur Heart J 2000; 21: 1301–1336.

7. Torbicki A et al. Guidelines of the European Cardiological Society for the Diagnosis and Management of Acute Pulmonary Embolism. Eur Heart J 2008; 29: 2276–2315.

8. Vaitkus PT, Leizorovicz A, Cohen AT et al. PREVENT Medical Thromboprophylaxis Study Group Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients. J Thromb Haemost 2005; 93: 76–79.

9. Noboa S, Mottier D, Oger E on behalf of EPI-GETBO Study Group. Estimation of a potentially preventable fraction of venous thromboembolism: a community‑based prospective study. J Thromb Haemost 2006; 4: 2720–2722.

10. Hansson PO, Welin L, Tibblin G et al. Deep vein thrombosis and pulmonary embolism in the general population. Arch Int Med 1997; 157: 1667–1670.

11. Cohen AT, Agnelli G, Anderson FA et al. Venous thromboembolism VTE in Europe (VITAE). Thromb Haemostas 2007; 98: 756–764.

12. Department of Health, Hospital Episode Statistics (HES), data 2004–2005. Available from: http/www.dh.gov.uk. Accessed February 27, 2007.

13. Nielsen HK, Bechgaard P, Nielsen PF et al. 178 fatal cases of pulmonary embolism in a medical department. Acta Med Scand 1981; 209: 351–355.

14. Sperry KL, Key CR, Anderson RE. Toward a population‑based assessment of death due to pulmonary embolism in New Mexico. Hum Pathol 1990; 21: 159–165.

15. Cohen AT, Edmondson RA, Phillips MJ et al. The changing pattern of venous thromboembolic disease. Haemostasis 1996; 26: 65–71.

16. Cohen AT, Tapson VF, Bergmann JF et al. ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: 387–394.

17. Turpie AG. Thrombosis prophylaxis in the acutely ill medical patient: insights from the prophylaxis in MEDical patients with ENOXaparin (MEDENOX) trial. Am J Cardiol 2000; 86: 48M–52M.

18. 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; 4: 341–346.

19. Leizorovicz A, Cohen AT, Turpie AG et al. PREVENT Medical Thromboprophylaxis Study Group. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110: 874–879.

20. Leizorovicz A, Mismetti P. Preventing venous thromboembolism in medical patients. Circulation 2004; 110 (Suppl 1): IV13–IV19.

21. Gerotziafas GT, Samama MM. Prophylaxis of venous thromboembolism in medical patients. Curr Opin Pulm Med 2004; 5: 356–365.

22. Geerts WH, Pineo GF, Heit JA et al. Prevention of venous thromboembolism. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl): 338S–400S.

23. Hirsh J, Guyatt G, Albers GW et al. American College of Chest Physicians. Evidence‑based clinical practice guidelines. 8th ed. Executive summary. Chest 2008; 133 (Suppl): 71S–109S.

24. Bernstein CN, Blanchard JF, Houston DS et al. The incidence of deep vein thrombosis and pulmonary embolism among patients with inflammatory bowel disease. Thromb Haemostas 2001; 85: 430–434.

25. Kleber FX, Witt C, Vogel G et al. THE-PRINCE Study Group 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.

26. Meyer G, Marjanovic Z, Valcke J et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002; 162: 1729–1735.

27. Lee AY, Levine MN, Baker RI et al. A randomized comparison of low-molecular-weight heparin with an oral anticoagulant for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146–153.

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

29. Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (Suppl 1): 9–16.

30. Le Gal G, Righini M, Roy PM et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006; 144: 165–171.

31. Malý R, Masopust J, Hosák L et al. Assessment of risk of venous thromboembolism and its possible prevention in psychiatric patients. Psychiatry Clin Neurosci 2008; 62: 3–8.

32. Goldhaber SZ, Tapson VF. DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259–262.

33. Kucher N, Koo S, Quirit R et al. Electronic alert to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352: 969–972.

34. Wolowacz SE, Roskell NS, Plumb JM et al. Efficacy and safety of dabigatran etexilate for the prevention of venous thromboembolism following total hip or knee arthroplasty. A meta‑analysis. Thromb Haemost 2009; 101: 77–85.

35. Botticelli Investigators, Writing Committe, Buller H, Deitchman D, Prins M et al. Efficacy and safety of the oral direct factor Xa inhibitor apixaban for symptomatic deep vein thrombosis. The Botticelli DVT dose‑ranging study. J Thromb Haemost 2008; 6: 1313–1318.

36. Eriksson BI, Borris LC, Friedman RJ et al. RECORD1 Study Group. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 26: 2765–2775.

37. Lassen MR, Ageno W, Borris LC et al. RECORD3 Investigators. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008; 358: 2776–2786.

38. Lohrmann J, Becker RC. New anticoagulants – the path from discovery to clinical practice. N Engl J Med 2008; 358: 2827–2829.