The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomised comparison

Sherman, David G.; Albers, Gregory W.; Bladin, Christopher; Fieschi, C.; Gabbai, Alberto Alain; Kase, Carlos S.; O’Riordan, William; Pineo, Graham F.

doi:10.1016/s0140-6736(07)60633-3

Cited by 280 publications

(216 citation statements)

References 27 publications

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“…The incidence of both VTE and DVT after 14 days was 18% with LDUH and 10% with enoxaparin, representing a significant 43% reduction in the relative risk for VTE and DVT with the use of enoxaparin versus LDUH (P < 0.001 for both comparisons). 22 The incidence of proximal DVT after 14 days was also significantly lower in the enoxaparin group (5%) compared with the LDUH group (10%, P < 0.001), as well as the incidence of distal DVT after 14 days in the enoxaparin group (7%) compared with the LDUH group (13%, P = 0.001). The 14-day incidence of PE was lower in the enoxaparin group (< 1%) than in the LDUH group (1%), although the difference was not significant (P = 0.059).…”

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confidence: 83%

“…20,21 The study examined 1,762 adults with acute ischemic stroke who were randomly assigned within 48 hours after symptom onset to receive LDUH (i.e., 5,000 units) subcutaneously every 12 hours or enoxaparin 40 mg subcutaneously every 24 hours for 10 days. 22 Modern methods were used to detect DVT (bilateral contrast venography or ultrasonography) and PE (ventilation perfusion, helical computed tomographic scanning, or pulmonary angiography). The incidence of both VTE and DVT after 14 days was 18% with LDUH and 10% with enoxaparin, representing a significant 43% reduction in the relative risk for VTE and DVT with the use of enoxaparin versus LDUH (P < 0.001 for both comparisons).…”

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confidence: 99%

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Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

Umland

2008

JMCP

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1 Most cases are asymptomatic; however, in approximately 600,000 cases, the thrombus embolizes and travels to the right atrium, through the right ventricle, and into the pulmonary arterial tree, lodging in the pulmonary vasculature. The mortality rate in patients with pulmonary embolism (PE) is high (approximately 10%), with nearly 60,000 deaths attributed to PE annually in the United States. Patients who survive PE may develop chronic pulmonary hypertension due to damage to the pulmonary vasculature. DVT can cause permanent damage to the valves of the venous system and may also result in post-thrombotic syndrome; chronic inflammation, edema, and pain; and, in severe cases, venous stasis ulcers of the lower extremities. ■■ PrevalenceVenous thromboembolism (VTE) risk factors are common among hospitalized patients. Using criteria established by the American College of Chest Physicians (ACCP) in their evidence-based guidelines for the prevention of VTE, review of a U.S. database containing more than 38 million inpatient discharge records showed that more than 12 million (31%) patients met the ACCP criteria for prophylaxis: 4.3 million surgical and 7.7 million medical patients.2,3 The larger number of medical patients at risk for VTE is significant because, although VTE risk is well recognized in surgical patients, the danger for medical patients is frequently underappreciated.While VTE is often considered to be a condition that develops primarily in elderly, bedridden hospital patients, recent medical record analysis provides a different picture. 4 A review of 1,897 VTE sufferers from Worcester, Massachusetts, showed that 74% of these patients developed VTE signs and symptoms as outpatients. The mean age of those 1,399 outpatients who developed VTE was 63 years, and 33% were aged < 55 years. In contrast, the mean age of the 498 inpatients who developed VTE was 67 years, with only 21% aged < 55 years. The presence of 5 VTE risk factors (recent hospitalization, recent surgery, active malignant neoplasm, recent infection, history of VTE) was ascertained in outpatients who developed VTE: 30% had no risk factors, 32% had 1, and 34% had 2-3. For patients who experienced VTE within 3 months after hospitalization (with or without surgery), two thirds experienced VTE within 1 month. The median and mean length of stay for this initial hospitalization was 4.0 and 7.4 days, respectively. It appears that an increased risk for VTE is present in the early post-discharge period after brief hospital stays for both medical and surgical patients.The risk of DVT without prophylaxis is 10%-20% in medical patients, 10%-80% for critical care patients, 20%-50% in patients ABSTRACT BACKGROUND: Venous thromboembolism (VTE) is a common and often preventable cause of morbidity and mortality in the United States, with a widespread economic impact.

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confidence: 83%

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confidence: 99%

Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

Umland

2008

JMCP

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“…As HBPM têm substituído a heparina não fracionada por possuírem menos efeitos indesejáveis como a resposta variável devido à ligação com proteínas plasmáticas ou a trombocitopenia induzida pela heparina (TIH) [1]. Além disso, diversos estudos realizados com modelos de trombose venosa em animais e estudos clínicos em humanos portadores de doenças venosas tromboembólicas mostraram que as HBPM são equivalentes ou até mesmo superiores à heparina não fracionada em relação ao seu efeito antitrombótico e possuem maior segurança por apresentar menor risco hemorrágico [5,14,17,18,19,20,21,22].…”

Section: Antitrombóticosunclassified

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

Borghesan¹

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“…As pulmonary embolism is found to be responsible for approximately 10% of deaths following an acute stroke, the prevention of this complication is of crucial importance (39,77). Prospective trials have shown that early heparin treatment with low molecular weight heparin (LMWH) is effective in reducing DVT and pulmonary embolism in stroke patients (112,113). Current guidelines recommend subcutaneous LMWH for DVT prophylaxis (39,77).…”

Section: Dvt Prophylaxismentioning

confidence: 99%

Acute Ischemic Stroke Management Review for the Hospitalist

Haldal¹,

Beary²,

Nattanmai³

et al. 2018

Am J Hosp Med

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The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomised comparison

Cited by 280 publications

References 27 publications

Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

Acute Ischemic Stroke Management Review for the Hospitalist

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