Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients

Amin, Alpesh; Varker, Helen; Princic, Nicole; Lin, Jay; Thompson, Stephen; Johnston, Stephen S.

doi:10.1002/jhm.1002

Cited by 122 publications

(114 citation statements)

References 18 publications

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“…6, [8][9][10][11][12] By comparison, in this multicenter, cross-sectional study, the documented use of anticoagulant thromboprophylaxis was 74% among patients with cancer considered eligible for anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

Zwicker

Rojan

Campigotto

et al. 2014

JCO

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A B S T R A C T PurposeHospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and MethodsWe conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. ResultsA total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P ϭ .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P Ͻ .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. ConclusionWe conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in hospitalized patients with cancer is commonly prescribed without regard to the presence or absence of concomitant risk factors for VTE.

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Section: Discussionmentioning

confidence: 99%

Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

Zwicker

Rojan

Campigotto

et al. 2014

JCO

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“…19,20 Current guidelines recommend the administration of pharmacological thromboprophylaxis for acutely ill patients at high risk for VTE during the entire hospitalisation period. 11,[23][24][25] The strongest predictor of post-discharge VTE was attributed to prior VTE history and rehospitalisation. 11,[23][24][25] The strongest predictor of post-discharge VTE was attributed to prior VTE history and rehospitalisation.…”

Section: Discussionmentioning

confidence: 99%

Extended duration of thromboprophylaxis for medically ill patients: a systematic review and meta‐analysis of randomised controlled trials

Zayed

Kheiri

Barbarawi

et al. 2020

Internal Medicine Journal

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Background The benefit of extended‐duration thromboprophylaxis in patients hospitalised for acute medical illness beyond hospital stay remains controversial. Aims To perform a meta‐analysis of randomised controlled trials (RCT) in order to examine the efficacy and safety of extended‐duration anticoagulation for venous‐thromboembolism (VTE) prophylaxis in this high‐risk population. Methods An electronic database search was conducted to include all RCT comparing between extended‐duration versus short‐duration prophylactic anticoagulation in medically ill patients. The primary efficacy outcome was the composite events of asymptomatic deep vein thrombosis (DVT), symptomatic VTE and death from VTE‐related causes. Results Five RCT were included totalling 40 124 patients, with a mean age of 71 years and 51% were male. In comparison to standard‐duration therapy, extended‐duration thromboprophylaxis was associated with a significant reduction in the primary efficacy outcome (risk ratio (RR) 0.75; 95% confidence interval (CI) 0.67–0.85; P < 0.01), symptomatic VTE (RR 0.53; 95% CI 0.33–0.84; P < 0.01) and asymptomatic DVT (RR 0.81; 95% CI 0.71–0.94; P < 0.01). However, there were no significant differences between both groups with regard to VTE‐related death (RR 0.81; 95% CI 0.60–1.10; P = 0.18) or all‐cause death (RR 0.97; 95% CI 0.88–1.08; P = 0.64). In contrast, extended‐duration thromboprophylaxis was associated with an increased risk of major bleeding (RR 2.04; 95% CI 1.42–2.91; P < 0.01) and non‐major clinically relevant bleeding (RR 1.81; 95% CI 1.29–2.53; P < 0.01). Conclusions Among hospitalised medically ill patients, prolonging venous thromboprophylaxis was associated with a decreased risk of composite events of the primary efficacy outcome and increased risk of bleeding with no significant difference in VTE‐related death.

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“…Today, acutely ill medical patients are typically hospitalized for 3–5 days and do not routinely receive prophylaxis after discharge . Several observational trials demonstrated that risk of VTE extends beyond hospitalization . This finding seems logical because patients do not resume their prehospital level of mobilization immediately upon discharge, and immobility may extend for some time after discharge.…”

Section: Venous Thromboembolism Inpatient Risk Assessment Model Per Amentioning

confidence: 99%

“…One study evaluated U.S. claims data following at‐risk medically ill patients for 180 days after admission and found that 56.6% of all VTE events occurred after discharge, with most of these events occurring within the first 30 days . One institution's VTE prophylaxis methods demonstrated that 89% of all VTE events occurred within 90 days after discharge .…”

Section: Venous Thromboembolism Inpatient Risk Assessment Model Per Amentioning

confidence: 99%

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients

2018

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Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with most events occurring within 30 days of hospital discharge. Therefore, the 30-day time period postdischarge has been identified as a stage in which patients are still at high risk of developing VTE. Attempts to provide extended prophylaxis with enoxaparin, rivaroxaban, or apixaban in patients with acute medical illness have been met with mixed results. Although some of these agents have reduced the incidence of VTE with extended prophylaxis, all of these agents have also demonstrated a significant increase in major bleeding that seems to offset any potential benefit. A recent trial of a new direct factor Xa inhibitor, betrixaban, demonstrated a reduction in VTE events with extended prophylaxis without significantly increasing the risk of major bleeding. Understanding appropriate patient selection, dosing, and outcomes associated with betrixaban will be important to potentially reducing the continued risk of VTE in patients with acute medical illness.

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Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients

Cited by 122 publications

References 18 publications

Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

Extended duration of thromboprophylaxis for medically ill patients: a systematic review and meta‐analysis of randomised controlled trials

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients

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