Thromb Haemost 2015; 113(06): 1216-1223
DOI: 10.1160/TH14-10-0823
Theme Issue Article
Schattauer GmbH

VTE primary prevention, including hospitalised medical and orthopaedic surgical patients

Serena Granziera
1   Department of Medicine (DIMED), University of Padova, Padova, Italy
,
Alexander T. Cohen
2   Department of Haematological Medicine, Guys and St Thomas’ NHS Foundation Trust, King’s College London, London, UK
› Author Affiliations
Further Information

Publication History

Received: 02 October 2014

Accepted after major revision: 23 February 2015

Publication Date:
18 November 2017 (online)

summary

Primary prevention is the key to managing a significant proportion of the burden of venous thromboembolism (VTE), defined as deep venous thrombosis (DVT) or pulmonary embolism (PE). This is because VTE may lead to sudden death or are often misdiagnosed and therefore treatment is not feasible. Primary prevention usually commences in hospital as VTE following hospitalisation adds to the significant disease burden worldwide. Numerous medical, surgical and other risk factors have been recognised and studied as indications for prophylaxis. The risk of VTE continues following admission to hospital with a medical or surgical condition, usually long after discharge and therefore prolonged primary prophylaxis is often recommended. Clinical and observational studies in surgical patients show this risk extends for months and perhaps more than one year, for medical patients the risk extends for at least several weeks. For the specific groups of patients at higher risk of developing VTE primary prevention, either pharmaceutical or mechanical, is recommended. The aim of this review is to describe the population at risk, the main related risk factors and the approach to thromboprophylaxis in different populations.

 
  • References

  • 1 Samama MM. et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 1999; 341: 793-800.
  • 2 Sweetland S. et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. Br Med J 2009; 339: b4583.
  • 3 Kahn SR. et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e195S-e226S.
  • 4 Cohen AT. et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008; 371: 387-394.
  • 5 Lindblad B. et al. Incidence of venous thromboembolism verified by necropsy over 30 years. Br Med J 1991; 302: 709-711.
  • 6 Kakkar N, Vasishta RK. Pulmonary embolism in medical patients: an autopsybased study. Clin Appl Thromb Hemost 2008; 14: 159-167.
  • 7 Heriot GS. et al. The four horsemen: clinicopathological correlation in 407 hospital autopsies. Intern Med J. 2010; 40: 626-632.
  • 8 Fraisse F. et al. 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.
  • 9 Beemath A. et al. Risk of venous thromboembolism in patients hospitalised with heart failure. Am J Cardiol 2006; 98: 793-795.
  • 10 Grainge MJ. et al. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet 2010; 375: 657-663.
  • 11 Alikhan R. et al. Risk factors for venous thromboembolism in hospitalised patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med 2004; 164: 963-968.
  • 12 Matta F. et al. Risk of venous thromboembolism with rheumatoid arthritis. Thromb Haemost 2009; 101: 134-138.
  • 13 Cohen AT. et al. Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 2005; 94: 750-759.
  • 14 Barbar S. et al. A risk assessment model for the identification of hospitalised medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010; 08: 2450-2457.
  • 15 Spyropoulos AC. et al. Predictive and associative models to identify hospitalised medical patients at risk for VTE. Chest 2011; 140: 706-714.
  • 16 Woller SC. et al. Derivation and validation of a simple model to identify venous thromboembolism risk in medical patients. Am J Med 2011; 124: 947-954 e2.
  • 17 Zakai NA. et al. Risk factors for venous thrombosis in medical inpatients: validation of a thrombosis risk score. J Thromb Haemost 2004; 02: 2156-2161.
  • 18 Nendaz M. et al. 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 2014; 111: 531-538.
  • 19 Leizorovicz A. et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110: 874-879.
  • 20 Cohen AT. et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. Br Med J 2006; 332: 325-329.
  • 21 Collaboration CT. et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 2009; 373: 1958-1965.
  • 22 Goldhaber SZ. et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 2011; 365: 2167-2177.
  • 23 Cohen AT. et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med 2013; 368: 1945-1946.
  • 24 Sharma A. et al. Extended thromboprophylaxis for medically ill patients with decreased mobility: does it improve outcomes?. J Thromb Haemost 2012; 10: 2053-2060.
  • 25 Dentali F. et al. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalised medical patients. Ann Intern Med 2007; 146: 278-288.
  • 26 Wein L. et al. Pharmacological venous thromboembolism prophylaxis in hospitalised medical patients: a meta-analysis of randomized controlled trials. Arch Intern Med 2007; 167: 1476-1486.
  • 27 Alikhan R. et al. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol 2004; 57: 1254-1257.
  • 28 Cohen AT. et al. The changing pattern of venous thromboembolic disease. Haemostasis 1996; 26: 65-71.
  • 29 Eriksson BI. et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358: 2765-2775.
  • 30 Hull RD. et al. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility: a randomized trial. Ann Intern Med 2010; 153: 8-18.
  • 31 Cohen AT. et al. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol. J Thromb Thrombolysis 2011; 31: 407-416.
  • 32 Cohen AT. et al. The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study. Am Heart J 2014; 167: 335-341.
  • 33 NIoH. A Study of Rivaroxaban (JNJ-39039039) on the Venous Thromboembolic Risk in Post-Hospital Discharge Patients (MARINER) Clinical Trials.gov 2014. Available from http://clinicaltrials.gov/ct2/show/NCT02111564?term=MARINER&rank=1 Accessed September 30, 2014.
  • 34 Decousus H. et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 2011; 139: 69-79.
  • 35 Gould MK. et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 2 Suppl e227S-e277S.
  • 36 Falck-Ytter Y. et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e278S-e325S.
  • 37 Cook D. et al. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med 2011; 364: 1305-1314.
  • 38 Arabi YM. et al. Use of intermittent pneumatic compression and not graduated compression stockings is associated with lower incident VTE in critically ill patients: a multiple propensity scores adjusted analysis. Chest 2013; 144: 152-159.
  • 39 Donati MB. Cancer and thrombosis. Haemostasis 1994; 24: 128-131.
  • 40 Falanga A, Donati MB. Pathogenesis of thrombosis in patients with malignancy. Int J Hematol 2001; 73: 137-144.
  • 41 Lip GY. et al. Cancer and the prothrombotic state. Lancet Oncol 2002; 03: 27-34.
  • 42 Sutherland DE. et al. Thromboembolic complications of cancer: epidemiology, pathogenesis, diagnosis, and treatment. Am J Hematol 2003; 72: 43-52.
  • 43 Heit JA. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245-1248.
  • 44 Akl EA. et al. Anticoagulation for patients with cancer and central venous catheters. Cochrane Database Syst Rev. 2011; 02: CD006468.
  • 45 Ay C. et al. Prediction of venous thromboembolism in cancer patients. Blood 2010; 116: 5377-5382.
  • 46 Gatt ME. et al. Is prolonged immobilisation a risk factor for symptomatic venous thromboembolism in elderly bedridden patients? Results of a historicalcohort study. Thromb Haemost 2004; 91: 538-543.
  • 47 Greer IA. Thrombosis in pregnancy: updates in diagnosis and management. Hematology Am Soc Hematol Educ Program 2012; 2012: 203-207.
  • 48 Kuipers S. et al. The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations. PLoS Med 2007; 04: e290.
  • 49 Belcaro G. et al. Prevention of venous thrombosis with elastic stockings during long-haul flights: the LONFLIT 5 JAP study. Clin Appl Thromb Hemost 2003; 09: 197-201.
  • 50 Guijarro R. et al. Venous thromboembolism and bleeding after total knee and hip arthroplasty. Findings from the Spanish National Discharge Database. Thromb Haemost 2011; 105: 610-615.
  • 51 Januel JM. et al. Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review. J Am Med Assoc 2012; 307: 294-303.
  • 52 Eriksson BI, Lassen MR. Investigators PEiH-FSP. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med 2003; 163: 1337-1342.
  • 53 Fisher WD. et al. Extended venous thromboembolism prophylaxis in patients undergoing hip fracture surgery – the SAVE-HIP3 study. Bone Joint J 2013; 95 -B 459-466.
  • 54 Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000; 355: 1295-1302.
  • 55 Collaborative overview of randomised trials of antiplatelet therapy--III: Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Antiplatelet Trialists’ Collaboration. Br Med J 1994; 308: 235-246.
  • 56 Cohen AT. et al. Antiplatelet treatment for thromboprophylaxis: a step forward or backwards?. Br Med J 1994; 309: 1213-1215.
  • 57 Eriksson BI. et al. Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, doubleblind, non-inferiority trial. Thromb Haemost 2011; 105: 721-729.
  • 58 Eriksson BI. et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the REMODEL randomized trial. Journal of thrombosis and haemostasis. J Thromb Haemost 2007; 05: 2178-2185.
  • 59 Eriksson BI. et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, doubleblind, non-inferiority trial. Lancet 2007; 370: 949-956.
  • 60 Kakkar AK. et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008; 372: 31-39.
  • 61 Lassen MR. et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008; 358: 2776-2786.
  • 62 Lassen MR. et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 2010; 363: 2487-2498.
  • 63 Lassen MR. et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet 2010; 375: 807-815.
  • 64 Turpie AG. et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet 2009; 373: 1673-1680.
  • 65 Kock HJ. et al. Thromboprophylaxis with low-molecular-weight heparin in outpatients with plaster-cast immobilisation of the leg. Lancet 1995; 346: 459-461.
  • 66 Bergqvist D, Lowe G. Venous thromboembolism in patients undergoing laparoscopic and arthroscopic surgery and in leg casts. Arch Intern Med 2002; 162: 2173-2176.
  • 67 Zagrodnick J, Kaufner HK. Ambulatory thromboembolism prevention in traumatology using self-injection of heparin. Unfallchirurg 1990; 93: 331-333.
  • 68 Abelseth G. et al. Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. J Orthop Trauma 1996; 10: 230-235.
  • 69 El-Daly I. et al. Thromboprophylaxis in patients with pelvic and acetabular fractures: A short review and recommendations. Injury 2013; 44: 1710-1720.
  • 70 Geerts WH. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 381S-453S.
  • 71 Demers C. et al. Incidence of venographically proved deep vein thrombosis after knee arthroscopy. Arch Intern Med 1998; 158: 47-50.
  • 72 Stringer MD. et al. Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients. J Bone Joint Surg Br vol 1989; 71: 492-497.
  • 73 Dattani R. et al. The venous thromboembolic complications of shoulder and elbow surgery: a systematic review. Bone Joint J 2013; 95 -B 70-74.
  • 74 Shah K. et al. Deep-Vein Thrombosis Prophylaxis in Foot and Ankle Surgery: What Is the Current State of Practice?. Foot Ankle Special. 2014. Epub ahead of print
  • 75 Geerts WH. et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994; 331: 1601-1606.
  • 76 Bergqvist D. Risk of venous thromboembolism in patients undergoing cancer surgery and options for thromboprophylaxis. J Surg Oncol 2007; 95: 167-174.
  • 77 Nagahiro I. et al. Intermittent pneumatic compression is effective in preventing symptomatic pulmonary embolism after thoracic surgery. Surg Today 2004; 34: 6-10.
  • 78 Kalweit G. et al. Pulmonary embolism: a frequent cause of acute fatality after lung resection. Eur J Cardiothorac Surg 1996; 10: 242-247.
  • 79 Dunning J. et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008; 34: 73-92.
  • 80 Morawski W. et al. Prediction of the excessive perioperative bleeding in patients undergoing coronary artery bypass grafting: role of aspirin and platelet glycoprotein IIIa polymorphism. J Thorac Cardiovasc Surg 2005; 130: 791-796.
  • 81 Salmaggi A. et al. Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: a systematic review. J Neurooncol 2013; 113: 293-303.
  • 82 Lee HM. et al. Deep vein thrombosis after major spinal surgery: incidence in an East Asian population. Spine 2000; 25: 1827-1830.
  • 83 Platzer P. et al. Thromboembolic complications after spinal surgery in trauma patients. Acta Orthop 2006; 77: 755-760.
  • 84 Ploumis A. et al. Thromboprophylaxis in traumatic and elective spinal surgery: analysis of questionnaire response and current practice of spine trauma surgeons. Spine 2010; 35: 323-329.
  • 85 Gynaecologists RCoOa. http://www.rcog.org.uk/files/rcog-corp/GTG37aReducingRiskThrombosis.pdf
  • 86 Bates SM. et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e691S-e736S.