Venous Thromboembolism Prophylaxis in Hospitalized Heart Failure Patients

Jois-Bilowich, P.; Michota, Frank; Bartholomew, John R.; Glauser, Jonathan; Diercks, Deborah B.; Weber, James E.; Fonarow, Gregg C.; Emerman, Charles L.; Peacock, W. Frank

doi:10.1016/j.cardfail.2007.10.017

Cited by 22 publications

(10 citation statements)

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“…A previously published analysis of ADHERE data found no overall association between inpatient VTE prophylaxis and in-hospital mortality. 22 Our results showing greater use of inotropic agents and longer length of stay in the prophylaxis cohort suggest that hospital clinicians may be more likely to administer VTE prophylaxis to sicker patients with HF.…”

Section: Discussionmentioning

confidence: 71%

Pharmacologic Prophylaxis for Venous Thromboembolism and 30‐Day Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis From the ADHERE National Registry Linked to Medicare Claims

Kociol

Hammill

Hernandez

et al. 2011

Clinical Cardiology

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Background: Hospitalized medically ill patients are at greater risk for venous thromboembolism (VTE). Although pharmacologic prophylaxis regimens have reduced VTE risk in medically ill patients, associations with early postdischarge adverse clinical outcomes among patients with heart failure are unknown. Hypothesis: We hypothesized that patients receiving pharmacologic VTE prophylaxis during hospitalization for heart failure would have lower rates of postdischarge adverse clinical outcomes than patients not receiving prophylaxis. Methods: Using data from the Acute Decompensated Heart Failure (ADHERE) registry linked to Medicare claims, we estimated 30-day postdischarge outcome rates for patients who received in-hospital subcutaneous heparin compared with patients who did not receive in-hospital VTE prophylaxis. We excluded patients who received warfarin or intravenous heparin. Outcomes included mortality, thromboembolic events, major adverse cardiovascular events, and all-cause readmission. We used propensity-score methods to estimate associations between VTE prophylaxis and each outcome. In a secondary analysis, we compared outcomes of patients receiving pharmacologic prophylaxis with unfractionated heparin (UFH) vs low-molecular-weight heparin (LMWH). Results: Of 36 799 eligible patients in 265 hospitals, 12 169 (33%) received pharmacologic VTE prophylaxis during the hospitalization. In unadjusted analysis and after weighting by the inverse probability of treatment, VTE prophylaxis was not associated with 30-day postdischarge mortality, thromboembolic events, major adverse cardiovascular events, or all-cause readmission. There were no differences in outcomes between patients receiving UFH and those receiving LMWH. Conclusions: Pharmacologic VTE prophylaxis is provided to one-third of older patients hospitalized with heart failure. Treatment with LMWH or UFH did not have a statistically significant association with 30-day postdischarge outcomes.

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Section: Discussionmentioning

confidence: 71%

Pharmacologic Prophylaxis for Venous Thromboembolism and 30‐Day Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis From the ADHERE National Registry Linked to Medicare Claims

Kociol

Hammill

Hernandez

et al. 2011

Clinical Cardiology

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“…[12][13][14][15] An analysis of U.S. registry data has shown that pharmacological VTE prophylaxis is provided to fewer than one-third of eligible patients hospitalized with New York Heart Association (NYHA) class III or IV HF. 16 Therefore, there is a need to identify patients with hospitalized HF who are at particularly high risk of VTE to facilitate the provision of optimal thromboprophylaxis. MAGELLAN (Multicenter, rAndomized, parallel Group Efficacy and safety study for the prevention of venous thromboembolism in hospitalized medically iLL patients comparing rivaroxabAN with enoxaparin) was a multicenter, randomized, double-blind phase III study in hospitalized, acutely ill patients, in which rivaroxaban (35±4 days) was compared with enoxaparin (10±4 days) followed by placebo.…”

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confidence: 99%

Predicting the Risk of Venous Thromboembolism in Patients Hospitalized With Heart Failure

et al. 2014

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Background-Whether heart failure (HF) increases the risk of venous thromboembolism (VTE) is not well established.In the phase III MAGELLAN (Multicenter, rAndomized, parallel Group Efficacy and safety study for the prevention of venous thromboembolism in hospitalized medically iLL patients comparing rivaroxabAN with enoxaparin) trial, extended-duration rivaroxaban was compared with standard-duration enoxaparin followed by placebo for VTE prevention in 8101 hospitalized acutely ill patients with or without HF. The aim of this analysis was to evaluate the relationship between HF severity and the risk of VTE in MAGELLAN patients. Methods and Results-Hospitalized patients diagnosed with HF were included according to New York Heart Association class III or IV at admission (n=2593). HF severity was determined by N-terminal probrain natriuretic peptide (NT-proBNP) plasma concentrations (median 1904 pg/mL). Baseline plasma D-dimer concentrations ranged from 0.6 to 1.7 μg/L for the less and more severe HF subgroups. Patients with more severe HF had a greater incidence of VTE versus patients with less severe HF, with a significant trend up to

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“…Full and prophylactic anticoagulation in acute HF -Use of anticoagulation with LMWH or UFH in patients with decompensated HF in the presence of atrial fibrillation, identification of intracavitary thrombus, mechanical valve prosthesis, with or without ventricular dysfunction 33,34 .…”

Section: Class Of Recommendation I Level Of Evidence Bmentioning

confidence: 99%

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

Montera¹,

Pereira²,

Colafranceschi³

et al. 2012

Arq. Bras. Cardiol.

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In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009.In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinicalhemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined.The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated.This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

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Venous Thromboembolism Prophylaxis in Hospitalized Heart Failure Patients

Cited by 22 publications

References 22 publications

Pharmacologic Prophylaxis for Venous Thromboembolism and 30‐Day Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis From the ADHERE National Registry Linked to Medicare Claims

Pharmacologic Prophylaxis for Venous Thromboembolism and 30‐Day Outcomes Among Older Patients Hospitalized With Heart Failure: An Analysis From the ADHERE National Registry Linked to Medicare Claims

Predicting the Risk of Venous Thromboembolism in Patients Hospitalized With Heart Failure

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

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