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 [
1‐
6]. 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 [
1‐
6]. 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 [
7‐
9]. …