Prophylaxis for Venous Thromboembolism: A Great Global Divide between Expert Guidelines and Clinical Practice?

Abstract

Our understanding of development and prevention of venous thromboembolism (VTE) has improved dramatically since Virchow described the triad of stasis, hypercoagulability, and endothelial dysfunction during the mid-1800s. A full arsenal of effective pharmacological and mechanical methods can help prevent VTE and many professional organizations have provided extensive evidence-based statements for VTE prophylaxis. Disappointingly, however, VTE has remained the major preventable cause of hospital death. Adherence rate to clinical guidelines is undesirably low. Many real-world patients have also been excluded from VTE prevention trials and hence practice guidelines recommendations. The comprehensive and repetitious formats of many available guidelines also limit their readability and applicability by nonthrombosis specialists. Moreover, some patients suffer from VTE despite complying with the contemporary prophylaxis regimens. Besides, significant heterogeneity exists in thromboprophylaxis practice and pitfalls between different countries. Last but not the least; although many at-risk patients are underprophylaxed, there is evidence to suggest that overprophylaxis (i.e., prescription of thromboprophylaxis in low-risk patients) comprises another important problem. We review the thromboprophylaxis practice and pitfalls around the world and provide recommendations on how the major obstacles can be overcome.

Correlation between rivaroxaban (Xarelto) plasma activity, patient clinical variables and outcomes in a South African centre

“…[1] Later low-molecular-weight heparin followed by a vitamin K antagonist became the recommended therapeutic regimen. [2] Vitamin K antagonists have also been the drugs of choice in preventing thrombo embolic events in patients with atrial fibrillation. The major problem with warfarin has been unpredictable pharmacodynamic and pharmacokinetic properties, including food and drug interactions, with resultant marked fluctuation in anticoagulation control in a significant number of patients.…”

Thromboembolic complications during pregnancy and delivery

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Patient Safety and Quality in Laboratory and Hemostasis Testing: A Renewed Loop?

“…While the problems of inappropriate test requests are often highlighted, recent data demonstrate that physicians face increasing difficulties in selecting the correct laboratory analyses due to the ever-increasing number and complexity of tests, the inadequacy of medical school training, and-at least for hemostasis-the insufficient awareness, compliance with, or even comprehension of, current guidelines and recommendations. [26][27][28][29] Within hemostasis testing, it was reported that physicians surprisingly experienced problems even in selecting the right test(s) for follow-up of common test abnormalities, such as a prolonged activated partial thromboplastin time (APTT). 30 Major challenges will likely emerge from monitoring of alternative anticoagulants, inasmuch as no definitive tests have been validated so far for agents such as lepirudin, and novel oral anticoagulants such as rivaroxaban, dabigatran, apixaban, and others.…”