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Extended duration of thromboprophylaxis in acutely ill medical patients: optimizing therapy?
Author(s) -
TURPIE A. G. G.
Publication year - 2007
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2006.02268.x
Subject(s) - medicine , intensive care medicine , placebo , population , clinical trial , venous thromboembolism , heparin , randomized controlled trial , thrombosis , alternative medicine , environmental health , pathology
Summary. Patients who are hospitalized for an acute medical illness are at risk of venous thromboembolism (VTE). Current evidence‐based guidelines recommend prophylaxis with unfractionated heparin or low‐molecular‐weight heparin in acutely ill medical patients who are admitted to hospital with congestive heart failure, severe respiratory disease, or who are bedridden with an additional VTE risk factor. The need for thromboprophylaxis is therefore clear in this patient population; however, the optimal duration of prophylaxis in these patients is less clear. In patients undergoing orthopedic or cancer surgery, extended‐duration prophylaxis has been shown to be superior to placebo. To date, however, no large‐scale clinical trials have assessed the benefits of extended‐duration prophylaxis in acutely ill medical patients. This review therefore focuses on the VTE risk profile of acutely ill medical patients, examines the currently available literature for evidence of a potential benefit of extended‐duration prophylaxis in these patients, and provides a rationale for the testing of such a hypothesis in a randomized clinical trial.