Prevention of VTE in the hospitalised patient: the evidence
Aberdeen, United Kingdom
Disclosure : I have received consultancy fees from Sanofi and Baxter in 2003 and Astra Zeneca in 2004. Since then I have eschewed such affiliations.
30 slide(s) – 00:23:35 – English – 2010-05-22
. The high rate of VTE during and after hospitalization
. The inadequacy of current strategies to deliver thrombophophylaxis and measures to overcome this.
. The evidence base for physical and pharmacological measures and combinations
. The evidence base for extended prophylaxis in selected cases.
Up to 50% of VTE follow hospital admission and the period at risk exceeds 8 weeks after surgical procedures. Day case surgery is associated with increased risk of VTE also. There is extensive evidence that adherence to recommendations on delivery of thromboprophylaxis is incomplete, especially in medical inpatients. Efforts to improve this are warranted including routine use of formal assessments for thrombosis and bleeding risk.
There is compelling evidence for the efficacy of anti-embolism stockings in surgical patients, although their efficacy in medical patients is less clear and a large randomised trial in stroke patients has shown no benefit. Other physical methods can be considered in selected patients.
LMWHs/fondaparinux are the pharmacological agents of choice at present for prophylaxis in most medical and surgical patients and there is evidence that combined physical and pharmacological approaches are even more effective. Extension of the period of pharmacological thrombophrophylaxis beyond the inpatient phase has been shown to be of benefit in high risk situations such as after hip arthroplasty. The new orally active inhibitors of thrombin or factor Xa are effective for thromboprophylaxis after hip and knee arthroplasty and may have wider applications in the future.
It is clear that effective tools for the prevention of VTE are available. Increased efforts are required now, to ensure their optimal use.