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14.03.2018 | IM - COMMENTARY

Prophylaxis of venous thromboembolism in Internal Medicine Units: the RAMs issue

verfasst von: Antonella Tufano, Giovanni Di Minno

Erschienen in: Internal and Emergency Medicine | Ausgabe 4/2018

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Excerpt

Venous thromboembolism (VTE), i.e., deep venous thrombosis (DVT) and pulmonary embolism (PE), is the third most frequent cardiovascular disorder, and is associated with a considerable disease burden. The prevalence of VTE is increasing with the growing world population and longer life expectancy [16]. Acutely ill hospitalized medical patients—including those with heart failure, severe lung disease, ischaemic stroke, cancer, acute infection, and rheumatologic disease—are at medium–high risk of VTE [16]. Primary pharmacological prophylaxis—begun at the time of admission and continued for the duration of stay in hospital—does not reduce the burden of VTE in such patients, in that it lowers the rate of thrombotic events and VTE-related death, with no effect on total mortality [3, 5, 6]. The net result is an unfavourable risk–benefit ratio at a population level, related, inter alia, to an inappropriate pharmacologic VTE prevention in low-risk patients and its limited use (either in intensity or in duration) in high-risk medically-ill patients. The combination of under or over-prescription argues against anticoagulant prophylaxis as being “appropriately used” in the heterogeneous population of medical patients [79]. …
Literatur
1.
Zurück zum Zitat Mahan CE, Fisher MD, Mills RM et al (2013) Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population. Thromb Res 132:520–526CrossRefPubMed Mahan CE, Fisher MD, Mills RM et al (2013) Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population. Thromb Res 132:520–526CrossRefPubMed
2.
Zurück zum Zitat Flanders SA, Greene MT, Grant P et al (2014) Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med 174:1577–1584CrossRefPubMed Flanders SA, Greene MT, Grant P et al (2014) Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med 174:1577–1584CrossRefPubMed
3.
Zurück zum Zitat Schulman S, Ageno W, Konstantinides SV (2017) Venous thromboembolism: past, present and future. Thromb Haemost 117:1219–1229CrossRefPubMed Schulman S, Ageno W, Konstantinides SV (2017) Venous thromboembolism: past, present and future. Thromb Haemost 117:1219–1229CrossRefPubMed
4.
Zurück zum Zitat Cimminiello C, Prandoni P, Agnelli G et al (2017) Thromboprophylaxis with enoxaparin and direct oral anticoagulants in major orthopedic surgery and acutely ill medical patients: a meta-analysis. Intern Emerg Med 12:1291–1305CrossRefPubMed Cimminiello C, Prandoni P, Agnelli G et al (2017) Thromboprophylaxis with enoxaparin and direct oral anticoagulants in major orthopedic surgery and acutely ill medical patients: a meta-analysis. Intern Emerg Med 12:1291–1305CrossRefPubMed
5.
Zurück zum Zitat Spyropoulos AC, Raskob GE (2017) New paradigms in venous thromboprophylaxis of medically ill patients. Thromb Haemost 117:1662–1670CrossRefPubMed Spyropoulos AC, Raskob GE (2017) New paradigms in venous thromboprophylaxis of medically ill patients. Thromb Haemost 117:1662–1670CrossRefPubMed
6.
Zurück zum Zitat Kahn SR, Lim W, Dunn AS et al (2012) American College of Chest Physicians. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e195S–e226SCrossRefPubMedPubMedCentral Kahn SR, Lim W, Dunn AS et al (2012) American College of Chest Physicians. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e195S–e226SCrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Cohen AT, Tapson VF, Bergmann J-F et al (2008) ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross sectional study. Lancet 371(9610):387–394CrossRefPubMed Cohen AT, Tapson VF, Bergmann J-F et al (2008) ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross sectional study. Lancet 371(9610):387–394CrossRefPubMed
8.
Zurück zum Zitat Marcucci M, Iorio A, Nobili A, REPOSI (REgistroPOliterapieSocieta` Italiana di Medicina Interna) Investigators et al (2013) Prophylaxis of venous thromboembolism in elderly patients with multimorbidity. Intern Emerg Med 8:509–520CrossRefPubMed Marcucci M, Iorio A, Nobili A, REPOSI (REgistroPOliterapieSocieta` Italiana di Medicina Interna) Investigators et al (2013) Prophylaxis of venous thromboembolism in elderly patients with multimorbidity. Intern Emerg Med 8:509–520CrossRefPubMed
9.
Zurück zum Zitat Violi F, Perri L, Loffredo L (2014) Interventional trials with anticoagulants in acutely ill medical patients: a methodological pitfall? Intern Emerg Med 8:461–464CrossRef Violi F, Perri L, Loffredo L (2014) Interventional trials with anticoagulants in acutely ill medical patients: a methodological pitfall? Intern Emerg Med 8:461–464CrossRef
10.
Zurück zum Zitat Barbar S, Noventa F, Rossetto V et al (2010) A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8:2450–2457CrossRefPubMed Barbar S, Noventa F, Rossetto V et al (2010) A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8:2450–2457CrossRefPubMed
11.
Zurück zum Zitat Nendaz M, Spirk D, Kucher N et al (2014) Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost 111:531–538CrossRefPubMed Nendaz M, Spirk D, Kucher N et al (2014) Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost 111:531–538CrossRefPubMed
12.
Zurück zum Zitat Spyropoulos AC, Anderson FA Jr, FitzGerald G, IMPROVE Investigators et al (2011) Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest 140:706–714CrossRefPubMed Spyropoulos AC, Anderson FA Jr, FitzGerald G, IMPROVE Investigators et al (2011) Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest 140:706–714CrossRefPubMed
13.
Zurück zum Zitat Decousus H, Tapson VF, Bergmann JF, IMPROVE Investigators et al (2011) Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 139:69–79CrossRefPubMed Decousus H, Tapson VF, Bergmann JF, IMPROVE Investigators et al (2011) Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 139:69–79CrossRefPubMed
14.
Zurück zum Zitat Hostler DC, Marx ES, Moores LK et al (2016) Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score. Chest 149:372–379CrossRefPubMed Hostler DC, Marx ES, Moores LK et al (2016) Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score. Chest 149:372–379CrossRefPubMed
15.
Zurück zum Zitat Stuck AK, Spirk D, Schaudt J, Kucher N (2017) Risk assessment models for venous thromboembolism in acutely ill medical patients. A systematic review. Thromb Haemost 117:801–808CrossRefPubMed Stuck AK, Spirk D, Schaudt J, Kucher N (2017) Risk assessment models for venous thromboembolism in acutely ill medical patients. A systematic review. Thromb Haemost 117:801–808CrossRefPubMed
16.
Zurück zum Zitat Nendaz MR, Chopard P, Lovis C et al (2010) Adequacy of venous thromboprophylaxis in acutely ill medical patients (impart): multisite comparison of different clinical decision support systems. J Thromb Haemost 8:1230–1234CrossRefPubMed Nendaz MR, Chopard P, Lovis C et al (2010) Adequacy of venous thromboprophylaxis in acutely ill medical patients (impart): multisite comparison of different clinical decision support systems. J Thromb Haemost 8:1230–1234CrossRefPubMed
17.
Zurück zum Zitat Kucher N, Koo S, Quiroz R et al (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352:969–977CrossRefPubMed Kucher N, Koo S, Quiroz R et al (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352:969–977CrossRefPubMed
18.
Zurück zum Zitat Kahn SR, Morrison DR, Cohen JM et al (2013) Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev 7:CD008201 Kahn SR, Morrison DR, Cohen JM et al (2013) Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev 7:CD008201
19.
Zurück zum Zitat Roy PM, Rachas A, Meyer G, PREVENU study group et al (2016) Multifaceted intervention to prevent venous thromboembolism in patients hospitalized for acute medical illness: a multicenter cluster-randomized trial. PLoS ONE 11:e0154832CrossRefPubMedPubMedCentral Roy PM, Rachas A, Meyer G, PREVENU study group et al (2016) Multifaceted intervention to prevent venous thromboembolism in patients hospitalized for acute medical illness: a multicenter cluster-randomized trial. PLoS ONE 11:e0154832CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Spirk D, Stuck AK, Hager A et al (2017) Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial. J Thromb Haemost 15:2138–2146CrossRefPubMed Spirk D, Stuck AK, Hager A et al (2017) Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial. J Thromb Haemost 15:2138–2146CrossRefPubMed
21.
Zurück zum Zitat Depietri L, Marietta M, Scarlini S et al (2018) Clinical impact of application of risk assessment models (Padua Prediction Score and Improve bleeding score) on venous thromboembolism, major haemorrhage and health expenditure associated with pharmacologic VTE prophylaxis: a “real life” prospective and retrospective observational study on patients hospitalized in a single internal medicine unit (The STIME study). Intern Emerg Med. https://doi.org/10.1007/s11739-018-1808-z PubMedCrossRef Depietri L, Marietta M, Scarlini S et al (2018) Clinical impact of application of risk assessment models (Padua Prediction Score and Improve bleeding score) on venous thromboembolism, major haemorrhage and health expenditure associated with pharmacologic VTE prophylaxis: a “real life” prospective and retrospective observational study on patients hospitalized in a single internal medicine unit (The STIME study). Intern Emerg Med. https://​doi.​org/​10.​1007/​s11739-018-1808-z PubMedCrossRef
22.
23.
Zurück zum Zitat Violi F, Perri L, Loffredo L (2013) Should all acutely ill medical patients be treated with antithrombotic drugs? A review of the interventional trials. Thromb Haemost 109:589–595CrossRefPubMed Violi F, Perri L, Loffredo L (2013) Should all acutely ill medical patients be treated with antithrombotic drugs? A review of the interventional trials. Thromb Haemost 109:589–595CrossRefPubMed
24.
Zurück zum Zitat Blondon M, Spirk D, Kucher N, Aujesky D, Hayoz D, Beer JH, Husmann M, Frauchiger B, Korte W, Wuillemin WA, Bounameaux H, Righini M, Nendaz M (2018) Comparative performance of clinical risk assessment models for hospital-acquired venous thromboembolism in medical patients. Thromb Haemost 118:82–89CrossRefPubMed Blondon M, Spirk D, Kucher N, Aujesky D, Hayoz D, Beer JH, Husmann M, Frauchiger B, Korte W, Wuillemin WA, Bounameaux H, Righini M, Nendaz M (2018) Comparative performance of clinical risk assessment models for hospital-acquired venous thromboembolism in medical patients. Thromb Haemost 118:82–89CrossRefPubMed
25.
Zurück zum Zitat Spirk D, Nendaz M, Aujesky D et al (2015) Predictors of thromboprophylaxis in hospitalised medical patients. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost 113:1127–1134CrossRefPubMed Spirk D, Nendaz M, Aujesky D et al (2015) Predictors of thromboprophylaxis in hospitalised medical patients. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost 113:1127–1134CrossRefPubMed
26.
Zurück zum Zitat La Regina M, Orlandini F, Marchini F et al (2016) Combined assessment of thrombotic and haemorrhagic risk in acute medical patients. Thromb Haemost 115:392–398CrossRefPubMed La Regina M, Orlandini F, Marchini F et al (2016) Combined assessment of thrombotic and haemorrhagic risk in acute medical patients. Thromb Haemost 115:392–398CrossRefPubMed
27.
Zurück zum Zitat Cohen AT, Harrington RA, Goldhaber SZ et al (2016) Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med 375:534–544CrossRefPubMed Cohen AT, Harrington RA, Goldhaber SZ et al (2016) Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med 375:534–544CrossRefPubMed
Metadaten
Titel
Prophylaxis of venous thromboembolism in Internal Medicine Units: the RAMs issue
verfasst von
Antonella Tufano
Giovanni Di Minno
Publikationsdatum
14.03.2018
Verlag
Springer International Publishing
Erschienen in
Internal and Emergency Medicine / Ausgabe 4/2018
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-018-1829-7

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