Abstract:Low molecular weight heparins are as effective as unfractionated heparin in deep-vein thrombosis (DVT) prophylaxis for major surgery. However, there is no evidence nor consensus for prophylaxis in medical patients. We compared the efficacy and safety of nadroparin calcium (nadroparin) with placebo in medical patients at high risk of DVT. A total of 223 patients mechanically ventilated for acute, decompensated chronic obstructive pulmonary disease, were randomized to treatment with subcutaneous nadroparin adjus… Show more
“…It has thus been recommended that all patients receive at least subcutaneous heparin, unless contraindicated (36). Several studies have been conducted comparing various heparins in specific patient groups (37)(38)(39)(40)(41), but very few have involved general ICU patients (42), and the most effective method of prophylaxis is still unclear. Clearly, the benefit of prophylaxis must be weighed against the risk of bleeding complications.…”
“…It has thus been recommended that all patients receive at least subcutaneous heparin, unless contraindicated (36). Several studies have been conducted comparing various heparins in specific patient groups (37)(38)(39)(40)(41), but very few have involved general ICU patients (42), and the most effective method of prophylaxis is still unclear. Clearly, the benefit of prophylaxis must be weighed against the risk of bleeding complications.…”
“…Among patients who died while in the ICU, PE was reported in 7% to 27% of postmortem examinations, and PE was thought to have caused or contributed to death in up to 12% of the patients (7)(8)(9)(10)(11). In the absence of thromboprophylaxis, the estimated rates of symptomatic and asymptomatic DVT range from 13% to 31% in critically ill patients (7), with the reported incidence being particularly high in the most recent trials (12,13).…”
There is a paucity of data assessing the risks and prevention of venous thromboembolism in critical care settings. Consequently, it is difficult to estimate the risk of venous thromboembolism for a typical patient, on an individual basis, and this difficulty leads to underuse of thromboprophylaxis, especially in intensive care unit patients. Thrombosis is a multifactorial disease and patients may present multiple risk factors simultaneously. The problem in quantifying risk factors is to combine these risk factors even when they are not detected in the same multivariate analysis. A model for predicting the risk of venous thromboembolism in hospitalized medical patients has yet to be developed and validated. Meanwhile, other approaches have been proposed to replace the ideal study utilizing a large prospective cohort of hospitalized medical patients. In this context, several scoring systems based on risk assessment models have been proposed, some including the use of computerized electronic prompts, to help physicians prescribe appropriate prophylaxis. This article reviews evidence on the risk of venous thromboembolism associated with different medical conditions and risk factors, and presents a tentative risk-assessment model for risk stratification in hospitalized medical patients.
“…L'anticoagulation par héparine non fractionnée à dose efficace n'est pas recommandée, sauf autre indication. La prophylaxie par héparines de bas poids moléculaire à posologie élevée, par voie sous-cutanée, est recommandée, comme la nardroparine 5000 UI anti-Xa ou l'énoxaparine 0,4 mL [38,39].…”
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