Approach to Outcome Measurement in the Prevention of Thrombosis in Surgical and Medical Patients (original) (raw)
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2012
2012;141;e120S-e151S Chest Jeffrey I. Weitz, John W. Eikelboom and Meyer Michel Samama Evidence-Based Clinical Practice Guidelines ed: American College of Chest Physicians Therapy and Prevention of Thrombosis, 9th New Antithrombotic Drugs : Antithrombotic http://chestjournal.chestpubs.org/content/141/2\_suppl/e120S.full.html services can be found online on the World Wide Web at: The online version of this article, along with updated information and ISSN:0012-3692 ) http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( written permission of the copyright holder. this article or PDF may be reproduced or distributed without the prior Dundee Road, Northbrook, IL 60062. All rights reserved. No part of Copyright2012by the American College of Chest Physicians, 3300 Physicians. It has been published monthly since 1935. is the official journal of the American College of Chest Chest
Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients
Thrombosis and Haemostasis, 2005
Hospitalizedp atientsw ith acute medicalc onditionsa re at significantriskofvenous thromboembolism (VTE): approximately 10-30% of general medical patients mayd evelop deep-vein thrombosis or pulmonaryembolism, andthe latter is aleading contributortodeaths in hospital. Despite consensus-group recommendations that at-riskm edical patients should receive thromboprophylaxis, there is currentlyn oc onsensusa st o which patients areatrisk,and manypatientsmay not receiveappropriate thromboprophylaxis.This paperreviews evidence for the risk of VTE associated with differentmedical conditions and riskfactors, and presents arisk-assessment modelfor risk stratification in medical patients. Medicalconditionsassociated with
Preventing venous thromboembolism in medical patients
1995
Given the increased number of patients hospitalized for acute medical illnesses and the associated risk of venous thromboembolism (VTE), the use of prophylaxis has become a public health matter. Thromboprophylaxis is not widely practiced in acutely ill medical patients, due in part to the heterogeneity of this group and the perceived difficulty in assessing those who would most benefit from treatment. Nevertheless, the results of recent well-conducted clinical trials support the evidence-based recommendations for more widespread systematic use of low-dose low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in this population. Three large well-controlled studies (MEDENOX, PREVENT, and ARTEMIS) in acutely ill medical patients confirm previous findings that different at-risk patient populations show a consistent 50% reduction in VTE events with LMWH and fondaparinux. A meta-analysis in nearly 5000 patients in internal medicine comparing UFH and LMWH revealed a trend for reduction of deep vein thrombosis and pulmonary embolism with LMWH. Based on duration of use in clinical trials in acutely ill medical patients, prophylactic treatment with UFH and LMWH is recommended for 2 weeks. (Circulation. 2004;110[suppl IV]:IV-13-IV-19.
SciMedicine Journal
Background: Venous thromboembolism (VTE) is a common and preventable disease among non-surgical hospitalized patients. Its incidence is high and alarming. Acute medical patients have VTE risk during and after hospitalization. The Padua prediction score is a risk model created to identify high VTE risk patients among non-surgical hospitalized patients. Methods: We performed a cross-sectional survey of 107 patients admitted to Internal Medicine wards who were assessed as acutely ill patients at Emergency Department, in a period of 4 weeks. The demographic and clinical data were collected using a designed questionnaire. VTE risk was defined as having a Padua Prediction score of ≥4 points. A statistical analysis was done to determine prevalence. The patients at high VTE risk received thromboprophylaxis. Results: One hundred and seven eligible patients were included. 84% were found to be at high risk for VTE. Among physiologically unstable patients, 60% of the patients were classified in...
Meta-analysis of venous thromboembolism prophylaxis in medically Ill patients
Clinical Therapeutics, 2007
Background: Venous thromboembolism (VTE) prophylaxis in medically ill patients has received a level 1A recommendation in previously published clinical guidelines. Pharmacologic prophylaxis for VTE includes unfractionated heparin (UFH), low-molecularweight heparin (LMWH), and fondaparinux. Few direct comparisons between anticoagulants exist in medically ill patients.
The Prophylaxis of Medical Patients for Thromboembolism Pilot Study
The American Journal of Medicine, 2006
We assessed the feasibility of a large randomized trial intended to determine whether low-dose heparin prophylaxis given throughout hospitalization reduces mortality and morbidity in general medical patients. SUBJECTS AND METHODS: Hospitalized general medical patients aged more than 60 years at 5 Department of Veterans Affairs (VA) medical centers were randomized to receive enoxaparin 40 mg or identical placebo, given daily by subcutaneous injection until hospital discharge. Outcomes included total mortality at 90 days (the primary outcome) and 1 year, and occurrence in the VA hospital within 90 days of symptomatic deep venous thrombosis, pulmonary embolism, and major bleeding. RESULTS: Only 7.6% of hospitalized patients aged more than 60 years were eligible for the study, although a chart review had predicted 25%. The principal exclusions were prior indication for anticoagulation, anticipated need for anticoagulation, contraindication to heparin, expected hospitalization less than 3 days, and "supportive/palliative care only" status. We randomized 140 patients into each group, 28% of target recruitment. The groups were well matched by age and comorbidities. Death occurred in 13 patients receiving enoxaparin and 14 patients receiving placebo at 90 days (relative risk 0.93, 95% confidence interval 0.26-1.59), and in 36 and 32 patients, respectively, at 1 year (relative risk 1.13, 95% confidence interval 0.66-1.60). Clinical thromboembolic events occurred in 5 patients receiving enoxaparin and 8 patients receiving placebo, and major bleeding occurred in 2 and 5 patients, respectively. CONCLUSIONS: The pilot study indicated that the full study was not feasible. The decision to use prophylaxis pertains to only a small proportion of general medical patients hospitalized at VA medical centers, and this proportion is overestimated by chart review. The effect of low-dose heparin prophylaxis on clinical outcomes in hospitalized general medical patients remains uncertain.
[Translated article] Multidisciplinary consensus for the management of pulmonary thromboembolism
Archivos De Bronconeumologia, 2022
We have updated recommendations on 12 controversial topics that were published in the 2013 National Consensus on the diagnosis, risk stratification and treatment of patients with pulmonary embolism (PE). A comprehensive review of the literature was performed for each topic, and each recommendation was evaluated in two teleconferences. For diagnosis, we recommend against using the Pulmonary Embolism Rule Out Criteria (PERC) rule as the only test to rule out PE, and we recommend using a d-dimer cutoff adjusted to age to rule out PE. We suggest using computed tomography pulmonary angiogram as the imaging test of choice for the majority of patients with suspected PE. We recommend using direct oral anticoagulants (over vitamin K antagonists) for the vast majority of patients with acute PE, and we suggest using anticoagulation for patients with isolated subsegmental PE. We recommend against inserting an inferior cava filter for the majority of patients with PE, and we recommend using full-dose systemic thrombolytic therapy for PE patients requiring reperfusion. The decision to stop anticoagulants at 3 months or to treat indefinitely mainly depends on the presence (or absence) and type of risk factor for venous thromboembolism, and we recommend against thrombophilia testing to decide duration of anticoagulation. Finally, we suggest against extensive screening for occult cancer in patients with PE.