Venous thromboembolism prophylaxis in medically ill patients: a mixed treatment comparison meta-analysis

Abstract

The American College of Chest Physicians guidelines recommend unfractionated heparin (UFH), low molecular weight heparins (LMWHs) or fondaparinux for prevention of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), in medically-ill patients. Direct oral anticoagulants (DOACs) have been evaluated relative to enoxaparin for VTE prophylaxis though head-to-head comparisons of these agents are lacking. Therefore, we conducted a mixed treatment comparisons meta-analysis to evaluate the safety and efficacy of established treatments and DOACs for VTE prophylaxis in medically-ill patients. A comprehensive literature search was conducted to identify randomized trials evaluating UFH, LMWHs or DOACS for the prevention of VTE in medically ill patients. Articles were retrieved and cross-referenced for additional trials, evaluated and entered into ADDIS (version 1.16.6) to generate direct and indirect treatment comparisons for VTE, DVT, PE, death from any cause, and bleeding. Ten articles were included and eight anticoagulants were evaluated in a treatment network representing data on 28,382 patients. We found each treatment had similar efficacy in preventing VTE, DVT, PE, death from any cause and each had similar risk of minor and major bleeding. Overall, placebo was associated with more VTE and DVT events compared to LMWHs and DOACs. We found that UFH, LMWHs and DOACs are comparable in preventing VTE, DVT, PE, and death from any cause and in association with minor and major bleeding. Anticoagulant selection for VTE prophylaxis in medically-ill patients should be individualized by patient characteristics, risks and preferences along with specific pharmacokinetic and pharmacodynamic considerations.

Incidence of venous thromboembolism in psychiatric inpatients: a chart review

“… 6 In comparison, our study showed a very high incidence of VTE (61.1%) in catatonic cases. It is possible that this seemingly high VTE percentage may be related to the following factors specific to this study: the incidence of PE that could not be detected by lower limb ultrasonography was high 44.4% (8/18), contrast-enhanced CT has a higher diagnostic rate of DVT compared to lower limb ultrasonography, 10 and heparin prophylaxis for prevention of VTE 11 was not performed in the current study. Previous studies have reported a DVT incidence of 11.6% in restrained patients, 5 as compared to the low value of 4.1% observed for VTE in this study.…”

Study of the bioaccumulation of tinzaparin in renally impaired patients when given at prophylactic doses - The STRIP study

“…Dear Editors, Low-molecular-weight heparins (LMWHs) are used for the prevention of venous thromboembolism (VTE) [1]. Compared to unfractionated heparin (UFH), they offer a number of advantages, including a simplified dosing schedule, improved adherence and decreased risk for heparin-induced thrombocytopenia [2,3]. Severe chronic kidney disease (CKD) represents a high risk for VTE in hospitalised patients (1)(2)(3).…”

“…Compared to unfractionated heparin (UFH), they offer a number of advantages, including a simplified dosing schedule, improved adherence and decreased risk for heparin-induced thrombocytopenia [2,3]. Severe chronic kidney disease (CKD) represents a high risk for VTE in hospitalised patients (1)(2)(3). Clinicians typically prefer UFH over LMWH for thromboprophylaxis in severe CKD because of concerns with bioaccumulation and possible increased risk for bleeding [4,5].…”

“…Continuous variables are given as median (interquartile range -IQR)2 Discrete variables are given as counts (%)3 eGFR = estimated glomerular filtration rate using CKD-EPI[8] …”

Menopausal Hormonotherapy and Venous Thromboembolic Events: Is There Any Correlation?

“…В отдаленном периоде после ТГВ формируется посттромботическая болезнь нижних конечностей или хроническая тромбоэмболическая легочная гипертензия (ХТЭЛГ). В первом случае происходит глубокая дезорганизация работы венозной системы нижних конечностей с высокой вероятностью развития трофических язв и рецидива венозного тромбоза, а при ХТЭЛГ формируется правожелудочковая недостаточность, напрямую связанная с массивностью поражения легочного русла [4]. Тяжелая ХТЭЛГ в течение 5 лет приводит к смерти 10-15% больных, перенесших массивную ТЭЛА.…”