An update on prevention of venous thromboembolism in hospitalized acutely ill medical patients
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BioMed Central
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An update on prevention of venous thromboembolism in hospitalized acutely ill medical patients Meyer Michel Samama*1 and Franz-Xaver Kleber2 Address: 1Départment d'Hématologie Biologique, Hôtel Dieu, Paris, France and 2Charité Medical School, Unfallkrankenhaus Berlin Academic Teaching Hospital, Berlin, Germany Email: Meyer Michel Samama* - [email protected]; Franz-Xaver Kleber - [email protected] * Corresponding author
Published: 03 July 2006 Thrombosis Journal 2006, 4:8
doi:10.1186/1477-9560-4-8
Received: 03 November 2005 Accepted: 03 July 2006
This article is available from: http://www.thrombosisjournal.com/content/4/1/8 © 2006 Samama and Kleber; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Both the recently updated consensus guidelines published by the American College of Chest Physicians, and the International Union of Angiology recommend thromboprophylaxis with either low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in medical patients at risk of VTE. However, no guidance is given regarding the appropriate dosing regimens that should be used for thromboprophylaxis in this patient group. LMWH (enoxaparin and dalteparin) and UFH have been shown to be effective for thromboprophylaxis in at-risk hospitalized medical patients. Although LMWH once daily (o.d.) has been shown to be as effective as UFH three times daily (t.i.d.) for thromboprophylaxis in at-risk medical patients, there are no data to show that UFH twice daily (b.i.d) is as effective as either LMWH o.d. or UFH t.i.d. On the basis of currently available evidence, the LMWHs enoxaparin and dalteparin are more attractive alternatives to UFH for the prevention of VTE in hospitalized medical patients because of their convenient once-daily administration and better safety profile, demonstrated in terms of reduced bleeding, HIT, and other adverse events.
Introduction In the absence of thromboprophylaxis, the incidence of venous thromboembolism (VTE) ranges from 10–20% in general medical patients to 80% in trauma patients, spinal cord injury patients, and patients in the critical care unit [1,2]. Despite evidence from large, randomized clinical studies demonstrating the benefits of providing thromboprophylaxis for hospitalized medical patients at risk of VTE [3-5], thromboprophylaxis is not currently prescribed to the extent that might be expected in this patient population, leaving many patients exposed to significant risk of acute thrombotic complications and their long-term consequences [6-9]. Consensus guidelines published by the American College of Chest Physicians (ACCP) and the International Union
of Angiology (IUA) recommend assessment of all hospitalized medical patients for the risk of VTE and the provision of appropriate thrombo
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