January 1, 2017Thrombosis and Haemostasis
New paradigms in venous thromboprophylaxis of medically ill patients
Why the study?
How should venous thromboprophylaxis be individualized in acutely-ill hospitalized medical patients to balance VTE and bleeding risks?
Population
Acutely-ill hospitalised medical patients
Design
Review
Authors
Discussion
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Member takes
Implication
Caution against universal thromboprophylaxis in medical inpatients; leaves open prospective validation of individualized risk models with biomarkers.
Key Points
- To review evolving evidence on venous thromboembolism and bleeding risks in acutely ill medical patients and assess individualized, risk-stratified thromboprophylaxis paradigms.
- Synthesized findings from global implementation audits and population-based studies assessing universal in-hospital thromboprophylaxis strategies.
- Reviewed outcomes from four large randomized placebo-controlled clinical trials investigating extended-duration post-discharge thromboprophylaxis.
- Evaluated validated clinical venous thromboembolism and bleeding risk assessment models alongside prospective studies of elevated D-dimer biomarkers.
- Universal in-hospital thromboprophylaxis fails to reduce the broader community burden of venous thromboembolism, which accounts for nearly one-quarter of attributable event risk.
- Four large randomized placebo-controlled trials of extended thromboprophylaxis failed to demonstrate a definitive net clinical benefit due to counterbalancing bleeding complications.
- Validated clinical risk assessment models and prospective D-dimer biomarker testing enable personalized risk stratification to balance antithrombotic efficacy against bleeding hazard.
Structured PICO
How should venous thromboprophylaxis be individualized in acutely-ill hospitalized medical patients to balance VTE and bleeding risks?
P
Population
Acutely-ill hospitalised medical patients
I
Intervention
Thromboprophylaxis (including extended thromboprophylaxis and individualized risk assessment models)
This review highlights the shift from universal to individualized, patient-centered venous thromboprophylaxis in medically ill patients using risk assessment models and biomarkers like D-dimer.
Cite This Study
Spyropoulos et al. (2017) studied this question.