Prophylactic treatment with 40 mg of enoxaparin subcutaneously per day safely and effectively reduces the risk of venous thromboembolism in patients with acute medical illnesses.

Background-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. Methods and Results-Patients (nϭ3706) 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; Pϭ0.0015). 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%). Conclusions-Dalteparin 5000 IU once daily halved the rate of venous thromboembolism with a low risk of bleeding.

Several independent risk factors for VTE were identified. These findings allow recognition of individuals at increased risk of VTE and will contribute to the formulation of an evidence-based risk assessment model for thromboprophylaxis in hospitalized general medical patients.

No abstract

The Medical Patients with Enoxaparin (MEDENOX) trial was a randomized, placebo-controlled study that defined the risk of venous thromboembolism (VTE) in acutely ill, immobilized, general medical patients and the efficacy of the low-molecular-weight heparin, enoxaparin, in preventing thrombosis. We performed a post-hoc analysis to evaluate the effect of 40 mg enoxaparin once daily on MEDENOX patient outcome in different types of acute medical illness (heart failure, respiratory failure, infection, rheumatic disorder and inflammatory bowel disease) and pre-defined risk factors (chronic heart and chronic respiratory failure, age, immobility, previous VTE and cancer). The primary outcome was the occurrence of documented VTE between days 1 and 14. The relative risk reduction [95% confidence intervals (CI)] for VTE comparing 40 mg enoxaparin with placebo in the subgroups were: acute heart failure, 0.29 (95% CI, 0.10-0.84); acute respiratory failure, 0.25 (95% CI, 0.10-0.65); acute infectious disease, 0.28 (95% CI, 0.09-0.81); and acute rheumatic disorder, 0.48 (95% CI, 0.11-2.16). The relative risk reduction for VTE in the pre-defined risk factor subgroups were: chronic heart failure, 0.26 (95% CI, 0.08-0.92); chronic respiratory failure, 0.26 (95% CI, 0.10-0.68); age, 0.22 (95% CI, 0.09-0.51); immobility, 0.53 (95% CI, 0.14-1.72); previous VTE, 0.49 (95% CI, 0.15-1.68); and cancer, 0.50 (95%o CI, 0.14-1.72). The beneficial effects of enoxaparin extend to a wide range of acutely ill medical patients.

Subcutaneous enoxaparin once or twice daily is as effective and safe as dose-adjusted, continuously infused unfractionated heparin in the prevention of recurrent symptomatic venous thromboembolic disease.

In this paper, we propose a practical and efficient method for finding the globally optimal solution to the problem of determining the pose of an object. We present a framework that allows us to use point-to-point, point-to-line, and point-to-plane correspondences for solving various types of pose and registration problems involving euclidean (or similarity) transformations. Traditional methods such as the iterative closest point algorithm or bundle adjustment methods for camera pose may get trapped in local minima due to the nonconvexity of the corresponding optimization problem. Our approach of solving the mathematical optimization problems guarantees global optimality. The optimization scheme is based on ideas from global optimization theory, in particular convex underestimators in combination with branch-and-bound methods. We provide a provably optimal algorithm and demonstrate good performance on both synthetic and real data. We also give examples of where traditional methods fail due to the local minima problem.

SummaryPlanar lung ventilation/perfusion scintigraphy (V/P PLANAR ) is a standard method for diagnosis of pulmonary embolism (PE). The goals of this study were to test whether the diagnostic information of ventilation/perfusion tomography (V/P SPET ) applied in clinical routine might enhance information compared with V/P PLANAR and to streamline data processing for the demands of clinical routine. This prospective study includes 53 patients suspected for PE referred for lung scintigraphy. After inhalation of 99m Tc-DTPA planar ventilation imaging was followed by tomography, using a dual-head gamma camera. 99m Tc-MAA was injected i.v. for perfusion tomography followed by planar imaging. Patients were examined in supine position, unchanged during V/P tomography. Two reviewers evaluated V/P PLANAR and V/P SPET images separately and randomly. Mismatch points were calculated on the basis of extension of perfusion defects with preserved ventilation. Patients were followed up clinically for at least 6 months. With V/P SPET the number of patients with PE was higher and 53% more mismatch points were found. In V/P SPET interobserver variation was less compared with V/P PLANAR . Ancillary findings were observed by both techniques in half of the patients but more precisely interpreted with V/P SPET . V/P SPET shows more and better delineated mismatch defects, improved quantification and less interobserver variation compared with V/P PLANAR . V/P SPET is amenable to implementation for clinical routine and suitable even when there is demand for a high patient throughput.