Discoveries in Thrombosis Care for Medical Patients

ABSTRACT

Medical patients represent the majority of hospitalized patients, and at least 75% of fatal pulmonary emboli occur in this group. Medical patients are at significant risk of thromboembolic disease, yet few are considered for thromboprophylaxis. Recent studies have identified the risk factor profiles in this group of patients, and a risk assessment model for medical patients has been developed. Risk stratification will help to ensure that patients receive appropriate thromboprophylaxis. It is clear that patients with severe chronic respiratory disease, congestive heart failure, and infectious disease are at high risk of symptomatic venous thromboembolism (VTE), particularly pulmonary embolism. Heparin-based prophylaxis significantly reduces the incidence of VTE. Low-molecular-weight heparin offers a safe and cost-effective alternative to unfractionated heparin in medical patients; to date, enoxaparin is the only low-molecular-weight heparin licensed for thromboprophylaxis in this indication.

KEYWORDS

Enoxaparin - low-molecular-weight heparin - risk factor profiles - thromboprophylaxis - venous thromboembolism

REFERENCES

• 1 Cohen A T, Edmondson R A, Philips M J, Ward V P, Kakkar V V. The changing pattern of venous thromboembolic disease.  Haemostasis . 1996;  26 65-71
• 2 Nielsen H K, Bechgaard P, Nielsen P F, Husted S E, Geday E. 178 fatal cases of pulmonary embolism in a medical department.  Acta Med Scand . 1981;  209 351-355
• 3 Hauch O, Jørgensen L N, Khattar S C. Fatal pulmonary embolism associated with surgery. An autopsy study.  Acta Chir Scand . 1990;  156 747-749
• 4 Sperry K L, Key C R, Anderson R E. Toward a population-based assessment of death due to pulmonary embolism in New Mexico.  Hum Pathol . 1990;  21 159-165
• 5 Samama M M. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study.  Arch Intern Med . 2000;  160 3415-3420
• 6 Cohen A T. Venous thromboembolic disease management of the nonsurgical moderate and high-risk patient.  Semin Hematol . 2000;  37(Suppl 5) 19-22
• 7 Samama M M, Cohen A T, Darmon J-Y. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients.  N Engl J Med . 1999;  341 793-800
• 8 Geerts W H, Heit J A, Clagett G P. Prevention of venous thromboembolism.  Chest . 2001;  119(Suppl 1) 132S-175S
• 9 Mismetti P, Laporte-Simitsidis S, Tardy B. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials.  Thromb Haemost . 2000;  83 14-19
• 10 Kleber F X, Witt C, Flosbach C W. Comparison of the low molecular weight heparin enoxaparin with unfractionated heparin in the prevention of venous thromboembolic events in medical patients with severe cardiopulmonary disease.  Thromb Haemost . 1999;  82 (Suppl) 492-(Abst 1552)
• 11 Kleber F X, Flosbach C W, Koppenhagen K. Comparison of the low molecular weight heparin enoxaparin with unfractionated heparin in the prevention of venous thromboembolic events in patients with heart failure NYHA III/IV (PRINCE II study).  Circulation . 1999;  100(Suppl 1) A3265
• 12 Hillbom M, Erilä T, Sotaniemi K. Enoxaparin versus heparin for the prevention of deep-vein thrombosis in acute ischaemic stroke: a randomised, double-blind study.  Acta Neurol Scand . 2002;  106 84-92
• 13 Fraisse F, Holzapfel L, Coulaud J-M. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France.  Am J Respir Crit Care Med . 2000;  161 1109-1114
• 14 Anderson Jr A F, Wheeler H B, Goldberg R J, Hosmer D W, Forcier A. Prevalence of risk factors for venous thromboembolism among hospital patients.  Arch Intern Med . 1992;  152 1660-1664
• 15 Lloyd A C, Anderson P M, Quinlan D J, Bearne A. Economic evaluation of the use of enoxaparin for thromboprophylaxis in acutely ill medical patients.  J Med Econ . 2001;  4 99-113