Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline

@article{Lederle2011VenousTP,
  title={Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline},
  author={Frank A. Lederle and Dylan M Zylla and Roderick MacDonald and Timothy J. Wilt},
  journal={Annals of Internal Medicine},
  year={2011},
  volume={155},
  pages={602 - 615}
}
BACKGROUND Venous thromboembolism prophylaxis has been recommended for nonsurgical patients, but its effectiveness remains uncertain. PURPOSE To assess the benefits and harms of prophylaxis in hospitalized adult medical patients and those with acute stroke. DATA SOURCES MEDLINE and the Cochrane Library from 1950 through April 2011, reference lists, and study authors. STUDY SELECTION English-language randomized trials were included if they provided clinical outcomes and evaluated therapy… Expand
Benefits versus risks of pharmacological prophylaxis to prevent symptomatic venous thromboembolism in unselected medical patients revisited. Meta-analysis of the medical literature
TLDR
In unselected medical patients, the rate of symptomatic VTE is lower than the reported overall VTE rate, and the benefit to risk ratio of pharmacological intervention for alleviating this condition in at-risk medical inpatient is questionable. Expand
Venous Thromboembolism Prophylaxis in Acute Medically ill Patients: A Retrospective Cohort Study.
TLDR
The current practice of routinely administering venous thromboembolism prophylaxis to medically ill patients considered at highrisk for thrombosis, resulted in a high risk for bleeding without a clear clinical benefit, and should be reassessed. Expand
Venous thromboembolism prophylaxis with anticoagulation in septic patients: a prospective cohort study.
TLDR
In acutely ill inpatients with sepsis, no significant benefit was demonstrated for VTE prophylaxis, with higher rates of bleeding, and the risk-benefit ratio of this intervention should be carefully examined. Expand
Prescribing patterns and outcomes of venous thromboembolism prophylaxis in hospitalized medical and cancer patients: Observations from the Ottawa Hospital.
TLDR
Overall, the study suggests that broad use of pharmacologic thromboprophylaxis may be unnecessary in select low-risk general medical patients and may be less effective in cancer patients in whom new studies are indicated. Expand
A Review of Venous Thromboembolism Prophylaxis for Hospitalized Medical Patients
TLDR
This work provides a comprehensive evidence-based clinical review of VTE prophylaxis for nonsurgical hospitalized patients, including risk factors and risk assessment, indications for proplylaxis, recommended therapeutic options, and updates from recently released practice guidelines by the American College of Physicians and the American Chest Physicians. Expand
Heparin Thromboprophylaxis in Medical-Surgical Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Trials*
TLDR
Trial evidence to date suggests that any type of heparin thromboprophylaxis decreases deep vein thromboembolism and pulmonary embolism in medical-surgical critically ill patients, and low-molecular-weight Heparin compared with bid unfractionatedheparin decreases pulmonary emblism and symptomatic pulmonary embolia. Expand
Heparin‐based treatment to prevent symptomatic deep venous thrombosis, pulmonary embolism or death in general medical inpatients is not supported by best evidence
TLDR
The use of HVTEp in hospitalised general medical patients does not result in a significant reduction in symptomatic DVT, PE, fatal PE or total mortality, and the best evidence does not support the recommendations of the current clinical guidelines. Expand
Thrombo-prophylaxis in acutely ill medical and critically ill patients
  • S. Saigal, J. Sharma, R. Joshi, D. Singh
  • Medicine
  • Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
  • 2014
TLDR
The prophylaxis may have reduced PE in acutely ill medical patients, but led to more bleeding events, thus resulting in no net benefit, and rivaroxaban offers a single-drug approach to the short-term and continued treatment of venous thrombosis. Expand
Thromboprophylaxis in medical inpatients reduces pulmonary embolism, increases the risk of major haemorrhage and does not reduce total mortality, producing questionable net clinical benefit
TLDR
A comprehensive meta-analysis of available clinical trials found the net benefit of VTE prevention strategies in unselected medical patients is not established. Expand
Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism : a cohort study.
TLDR
The occurrence of 90-day VTE in medical patients after hospitalization is low and patients who receive care at hospitals that have lower rates of pharmacologic prophylaxis do not have higher adjusted hazards of VTE, even after adjusting for potential confounders. Expand
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