The Prophylaxis of Medical Patients for Thromboembolism Pilot Study

Prevention of venous thromboembolism in hospitalized medical patients: addressing some practical questions

“…Most studies assessing anticoagulant prophylaxis have relied on asymptomatic venography-detected or ultrasound-detected DVT as a measure of efficacy against no prophylaxis [10,[36][37][38][39][40][41][42][43]. Meta-analyses have consistently demonstrated that anticoagulants reduce the risk for DVT by 39-60% and proximal DVT by 49-69% [11,12 ].…”

Comparison of the efficacy and safety of low molecular weight heparins for venous thromboembolism prophylaxis in medically ill patients

“…A total of 20 trials enrolling 37,284 patients met inclusion criteria ( Figure 1, Table 1) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] . There were four trials comparing enoxaparin to placebo, three trials comparing enoxaparin to UFH, two trials comparing nadroparin to UFH, two trials comparing nadroparin to placebo, one trial comparing dalteparin to placebo, three trials comparing certoparin to UFH, four trials comparing UFH to control, and one trial comparing fondaparinux to placebo.…”

“…Patients enrolled were typically immobilized for several days (6-28 days). The majority of the trials enrolled similar proportions of males and females with the exception of Lederle et al, which consisted of over 97% of males 20 . The average age was greater than 60 years and patients averaged weights between 57 and 85.5 kg, although eight trials did not report weight.…”

Thrombo-prophylaxis in acutely ill medical and critically ill patients

“…[12141516] This surrogate outcome is much more common than clinically evident disease, and its value has been questioned previously. [171819] There has been a lot of controversy in this field and various trials until date had showed conflicting results. Meta-analysis by Lederle et al .…”

“…Forty unique randomized trials involving >52,000 patients were ultimately identified. Of these 21 were conducted in medical patients, of which 10 compared prophylaxis with heparin or related agents with no heparin,[121415161922232425] 9 compared LMWH with UFH,[82627282930313233] and 2 compared different durations of LMWH prophylaxis. [3435] Nineteen trials were conducted in patients with acute stroke, of which 8 compared heparin prophylaxis with no heparin,[3637383940414243] five compared LMWH with UFH,[4445464748] three compared mechanical with no mechanical prophylaxis,[495051] and three had unique designs.…”