37
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      What has changed in venous thromboembolism prophylaxis for hospitalized patients over recent decades: review article

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis.

          Related collections

          Most cited references78

          • Record: found
          • Abstract: found
          • Article: not found

          Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

          This article discusses the prevention of venous thromboembolism (VTE) and is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggestions imply that individual patient values may lead to different choices (for a full discussion of the grading, see the "Grades of Recommendation" chapter by Guyatt et al). Among the key recommendations in this chapter are the following: we recommend that every hospital develop a formal strategy that addresses the prevention of VTE (Grade 1A). We recommend against the use of aspirin alone as thromboprophylaxis for any patient group (Grade 1A), and we recommend that mechanical methods of thromboprophylaxis be used primarily for patients at high bleeding risk (Grade 1A) or possibly as an adjunct to anticoagulant thromboprophylaxis (Grade 2A). For patients undergoing major general surgery, we recommend thromboprophylaxis with a low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or fondaparinux (each Grade 1A). We recommend routine thromboprophylaxis for all patients undergoing major gynecologic surgery or major, open urologic procedures (Grade 1A for both groups), with LMWH, LDUH, fondaparinux, or intermittent pneumatic compression (IPC). For patients undergoing elective hip or knee arthroplasty, we recommend one of the following three anticoagulant agents: LMWH, fondaparinux, or a vitamin K antagonist (VKA); international normalized ratio (INR) target, 2.5; range, 2.0 to 3.0 (each Grade 1A). For patients undergoing hip fracture surgery (HFS), we recommend the routine use of fondaparinux (Grade 1A), LMWH (Grade 1B), a VKA (target INR, 2.5; range, 2.0 to 3.0) [Grade 1B], or LDUH (Grade 1B). We recommend that patients undergoing hip or knee arthroplasty or HFS receive thromboprophylaxis for a minimum of 10 days (Grade 1A); for hip arthroplasty and HFS, we recommend continuing thromboprophylaxis > 10 days and up to 35 days (Grade 1A). We recommend that all major trauma and all spinal cord injury (SCI) patients receive thromboprophylaxis (Grade 1A). In patients admitted to hospital with an acute medical illness, we recommend thromboprophylaxis with LMWH, LDUH, or fondaparinux (each Grade 1A). We recommend that, on admission to the ICU, all patients be assessed for their risk of VTE, and that most receive thromboprophylaxis (Grade 1A).
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study.

            Information about the variation in the risk for venous thromboembolism (VTE) and in prophylaxis practices around the world is scarce. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study is a multinational cross-sectional survey designed to assess the prevalence of VTE risk in the acute hospital care setting, and to determine the proportion of at-risk patients who receive effective prophylaxis. All hospital inpatients aged 40 years or over admitted to a medical ward, or those aged 18 years or over admitted to a surgical ward, in 358 hospitals across 32 countries were assessed for risk of VTE on the basis of hospital chart review. The 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines were used to assess VTE risk and to determine whether patients were receiving recommended prophylaxis. 68 183 patients were enrolled; 30 827 (45%) were categorised as surgical, and 37 356 (55%) as medical. On the basis of ACCP criteria, 35 329 (51.8%; 95% CI 51.4-52.2; between-country range 35.6-72.6) patients were judged to be at risk for VTE, including 19 842 (64.4%; 63.8-64.9; 44.1-80.2) surgical patients and 15 487 (41.5%; 41.0-42.0; 21.1-71.2) medical patients. Of the surgical patients at risk, 11 613 (58.5%; 57.8-59.2; 0.2-92.1) received ACCP-recommended VTE prophylaxis, compared with 6119 (39.5%; 38.7-40.3; 3.1-70.4) at-risk medical patients. A large proportion of hospitalised patients are at risk for VTE, but there is a low rate of appropriate prophylaxis. Our data reinforce the rationale for the use of hospital-wide strategies to assess patients' VTE risk and to implement measures that ensure that at-risk patients receive appropriate prophylaxis.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients.

              Considerable variability exists in the use of pharmacological thromboprophylaxis among acutely ill medical patients, partly because clinically relevant end points have not been fully assessed in this population. We undertook an international, multicenter, randomized, double-blind, placebo-controlled trial using clinically important outcomes to assess the efficacy and safety of dalteparin in the prevention of venous thromboembolism in such patients. Patients (n=3706) were randomly assigned to receive either subcutaneous dalteparin 5000 IU daily or placebo for 14 days and were followed up for 90 days. The primary end point was venous thromboembolism, defined as the combination of symptomatic deep vein thrombosis, symptomatic pulmonary embolism, and asymptomatic proximal deep vein thrombosis detected by compression ultrasound at day 21 and sudden death by day 21. The incidence of venous thromboembolism was reduced from 4.96% (73 of 1473 patients) in the placebo group to 2.77% (42 of 1518 patients) in the dalteparin group, an absolute risk reduction of 2.19% or a relative risk reduction of 45% (relative risk, 0.55; 95% CI, 0.38 to 0.80; P=0.0015). The observed benefit was maintained at 90 days. The overall incidence of major bleeding was low but higher in the dalteparin group (9 patients; 0.49%) compared with the placebo group (3 patients; 0.16%). Dalteparin 5000 IU once daily halved the rate of venous thromboembolism with a low risk of bleeding.
                Bookmark

                Author and article information

                Journal
                J Vasc Bras
                J Vasc Bras
                jvb
                Jornal Vascular Brasileiro
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
                1677-5449
                1677-7301
                30 January 2019
                2019
                : 18
                : e20180021
                Affiliations
                [1 ] original Faculdade Regional de Medicina de São José do Rio Preto – FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.
                [2 ] original Hospital Austa, São José do Rio Preto, SP, Brasil.
                [3 ] original Faculdade de Medicina em São José do Rio Preto – FACERES, São José do Rio Preto, SP, Brasil.
                [1 ] original Faculdade Regional de Medicina de São José do Rio Preto – FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.
                [2 ] original Hospital Austa, São José do Rio Preto, SP, Brasil.
                [3 ] original Faculdade de Medicina em São José do Rio Preto – FACERES, São José do Rio Preto, SP, Brasil.
                Author notes

                Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

                CorrespondenceSelma Regina de Oliveira Raymundo Rua Antonio Bahia Monteiro, 465, sala 221 - Parque Residencial Mançour Daud CEP 15070-450 - São José do Rio Preto (SP), Brasil Tel.: +55 (17) 99601-6062 E-mail: selma_ray@ 123456terra.com.br

                Author information SROR - MSc in Health Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP); Adjunct professor II-M, Serviço de Cirurgia Vascular e Angiologia, Departamento de Cardiologia e Cirurgia Vascular, Faculdade de Medicina de São José do Rio Preto; Full member, Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV); Board-certified in Angiology and Vascular Surgery, SBACV; Physician, Hospital Austa.

                SMAL - Tenured professor, Faculdade de Medicina de São José do Rio Preto (FAMERP); Research adjunct director, Faculdade de Medicina de São José do Rio Preto; Chief, Serviço de Terapia Intensiva, Hospital de Base de São José do Rio Preto; Chief, Laboratório de Sepse, FAMERP; Board-certified in Intensive Therapy, Associação de Medicina Intensiva Brasileira (AMIB); Board-certified in Parenteral and Enteral Nutrition, Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE); Elected future director (2020-2021), AMIB.

                KMKH - Adjunct professor II-E, Faculdade de Medicina de São José do Rio Preto; Chief, Serviço de Vias Biliares e Pâncreas, Hospital de Base de São José do Rio Preto; Executive director, Grupo Austa.

                KGH - Medical student, Faculdade FACERES.

                ITS - Medical student, Faculdade FACERES.

                Author contributions Conception and design: SROR, KMKH, SMAL Analysis and interpretation: SROR, SMAL Data collection: SROR, KMKH, KGH, ITS Writing the article: SROR, KMKH, SMAL, KGH, ITS Critical revision of the article: SROR, KMKH, SMAL Final approval of the article*: SROR, KMKH, SMAL, KGH, ITS Statistical analysis: N/A. Overall responsibility: SROR * All authors have read and approved of the final version of the article submitted to J Vasc Bras.

                Conflitos de interesse: Os autores declararam não haver conflitos de interesse que precisam ser informados.

                Correspondência Selma Regina de Oliveira Raymundo Rua Antonio Bahia Monteiro, 465, sala 221 - Parque Residencial Mançour Daud CEP 15070-450 - São José do Rio Preto (SP), Brasil Tel.: (17) 99601-6062 E-mail: selma_ray@ 123456terra.com.br

                Informações sobre os autores:

                SROR - Mestre em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto (FAMERP); Professora adjunta II-M, Serviço de Cirurgia Vascular e Angiologia, Departamento de Cardiologia e Cirurgia Vascular, Faculdade de Medicina de São José do Rio Preto; Titular, Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV); Especialista em angiologia e cirurgia vascular, SBACV; Médica do Hospital Austa.

                SMAL - Livre-docente, Faculdade de Medicina de São José do Rio Preto (FAMERP); Diretora adjunta de Pesquisa, Faculdade de Medicina de São José do Rio Preto; Chefe, Serviço de Terapia Intensiva, Hospital de Base de São José do Rio Preto; Chefe, Laboratório de Sepse, FAMERP; Especialista em terapia intensiva, Associação de Medicina Intensiva Brasileira (AMIB); Especialista em nutrição parenteral e enteral, Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE); Diretora futura (2020-2021), AMIB.

                KMKH - Professor Adjunto II-E, Faculdade de Medicina de São José do Rio Preto; Chefe, Serviço de Vias biliares e pâncreas, Hospital de Base de São José do Rio Preto; Diretor executivo, grupo Austa.

                KGH - Discente de Medicina, Faculdade FACERES.

                ITS - Discente de Medicina, Faculdade FACERES.

                Contribuição dos autores Concepção e desenho do estudo: SROR, KMKH, SMAL Análise e interpretação dos dados: SROR, SMAL Coleta de dados: SROR, KMKH, KGH, ITS Redação do artigo: SROR, KMKH, SMAL, KGH, ITS Revisão crítica do texto: SROR, KMKH, SMAL Aprovação final do artigo*: SROR, KMKH, SMAL, KGH, ITS Análise estatística: N/A. Responsabilidade geral pelo estudo: SROR *Todos os autores leram e aprovaram a versão final submetida do J Vasc Bras.

                Author information
                http://orcid.org/0000-0001-8705-7146/
                Article
                jvbAR20180021_PT 00402
                10.1590/1677-5449.002118
                6542320
                8beb619b-c2a5-41d9-a119-4645f13c5fad

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 May 2018
                : 13 November 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 74
                Categories
                Review Article

                venous thromboembolism,prevention & control,anticoagulants,tromboembolismo venoso,prevenção & controle,anticoagulantes

                Comments

                Comment on this article

                scite_

                Similar content603

                Cited by3

                Most referenced authors1,265