Preventing Venous Thromboembolism in Medical Patients

Leizorovicz, Alain; Mismetti, Patrick

doi:10.1161/01.cir.0000150640.98772.af

Cited by 54 publications

(45 citation statements)

References 38 publications

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“…Although heparin-based anticoagulants have a weight of evidence demonstrating their benefit in preventing VTE in postoperative and medical inpatients (12)(13)(14), they are also associated with higher bleeding complication rates than are antiplatelet medication (15). Traditionally, it was argued that antiplatelet agents were ineffective as VTE prophylaxis because of the prothrombotic milieu in veins featuring platelet-independent, low-flow fibrin aggregation.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas

Ziaj

Condon

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Venous thromboembolism (VTE) occurs in 7%-40% of nephrotic patients. The risk of VTE depends on the severity and underlying cause of nephrotic syndrome. This study investigated the use of low-dose prophylactic anticoagulation to prevent VTE in patients with nephrotic syndrome caused by primary glomerulonephritis.Design, setting, participants, & measurements Since 2006, all patients presenting with nephrotic syndrome to Imperial College Kidney and Transplant Centre have been considered for treatment with a novel anticoagulation prophylaxis regimen. All cases of nephrotic syndrome secondary to primary membranous nephropathy, minimal-change disease, and FSGS over a 5-year period were retrospectively reviewed. Patients with serum albumin,2.0 g/dl received prophylactic-dose low-molecular-weight heparin or low-dose warfarin; patients with albumin levels of 2.0-3.0 g/dl received aspirin, 75 mg once daily. All thrombotic events and bleeding complications were recorded.Results A total of 143 patients received the prophylactic anticoagulation regimen. Median follow-up was 154 weeks (range, 30-298 weeks). The cohort had features associated with a high risk of developing VTE; 40% of the cohort had an underlying diagnosis of membranous nephropathy, and the initial median serum albumin was 1.5 g/dl (range, 0.5-2.9 g/dl). No VTE occurred in patients established on prophylaxis for at least 1 week. VTE was diagnosed in 2 of 143 patients (1.39%) within the first week after presentation and starting prophylaxis. In both cases, it is unclear whether the thrombus had developed before or after the start of prophylaxis. One of 143 (0.69%) patients receiving prophylaxis was admitted urgently with gastrointestinal hemorrhage. Two of 143 patients (1.40%) had elective blood transfusions and procedures to manage occult gastrointestinal bleeding. No other bleeding events occurred in patients receiving prophylaxis.Conclusions This regimen of prophylactic antiplatelet or anticoagulant therapy appears effective in preventing VTE in nephrotic syndrome, with relatively few hemorrhagic complications.

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Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Medjeral-Thomas

Ziaj

Condon

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…After completion of the audit, we estimated the number needed to prevent one maternal death, assuming that half of episodes are already prevented. 4 This is likely to be an overestimate. This project started as an in-house audit.…”

Section: Methodsmentioning

confidence: 99%

“…3 Studies suggest that use of low-molecular-weight heparin (LMWH) can reduce VTE in medical patients by 50%. 4 Recent guidance documents on provision of thromboprophylaxis have been published by the Royal College of Obstetricians and Gynaecologists (RCOG) (2009) and National Institute for Health and Clinical Excellence (NICE) (2010). 5,6 RCOG guidance covers all aspects of maternity care.…”

Section: Introductionmentioning

confidence: 99%

Financial implications and maternal impact of national recommendations for thromboprophylaxis: a retrospective cross-sectional analysis

Bond¹,

O'Brien²,

Fox³

2011

Obstet Med

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SummaryBackground: Thromboembolism was a leading direct cause of maternal death in the UK in the last Saving Mothers' Lives report. National guidance proposes that all women should be risk assessed in pregnancy and after delivery. Methods: An audit was designed to assess the financial implication for our service. One hundred consecutive live and stillbirths were identified using the maternity database; 97 case records were obtained. Risk factors were identified and individual scores were calculated, together with the proportion that would have extended measures (low-molecular-weight heparin [LMWH], antiembolic stockings). Results: The series appeared to be representative of the UK pregnant population in terms of age, parity, body mass index, smoking and caesarean rate. Antenatally, 2.1% had a Royal College of Obstetricians and Gynaecologists (RCOG) risk score of three or more and would have been advised to have LMWH throughout pregnancy and the puerperium. Postnatally, 40.1% had an RCOG score of two or more and would have required enoxaparin for one to six weeks. The annual cost of stockings, LMWH and sharps bins approximate to GB£44,847 for every one thousand deliveries, GB£2.6 million for each life saved. About 10% of normal-weight postnatal women who achieved a vaginal birth had a risk score prompting thromboprophylaxis for at least seven days. Conclusions These data suggest that the current guidance might represent overmedicalization of pregnancy and that the criteria for thromboprophylaxis should be refined further.

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“…(34) Recomenda-se avaliar todos os casos de pacientes internados com doença clínica aguda, imobilização projetada para 3 ou mais dias e na presença de fatores de risco adicionais. (A) (35) Um grupo de trabalho da Associação Médica Brasileira, através de uma revisão sistemática da literatura, elaborou recomendações atuais de profilaxia para pacientes clínicos, que são apresentadas na Figura 4. (36,37) A síndrome da classe econômica, inicialmente descrita em médicos que realizavam longas viagens aéreas e desenvolviam TEV, foi o primeiro indício que as viagens poderiam ser um fator de risco.…”

Section: Profilaxia De Tev Em Pacientes Clínicosunclassified

Tromboprofilaxia primária

2010

J. bras. pneumol.

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Preventing Venous Thromboembolism in Medical Patients

Cited by 54 publications

References 38 publications

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Retrospective Analysis of a Novel Regimen for the Prevention of Venous Thromboembolism in Nephrotic Syndrome

Financial implications and maternal impact of national recommendations for thromboprophylaxis: a retrospective cross-sectional analysis

Tromboprofilaxia primária

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