Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease

Kleber, F. X.; Witt, Christian; Vogel, G; Koppenhagen, K; Schomaker, Ulrike; Flosbach, C W

doi:10.1067/mhj.2003.189

Cited by 269 publications

(212 citation statements)

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“…These tools consisted of both standard admission history and physical forms, which included a VTE risk stratification scheme, and a standard admission order form that included optimal VTE prevention regimens. The authors collectively felt that optimal data-supported preventive regimens in this patient population were either enoxaparin 40 mg subcutaneously once daily or unfractionated heparin 5,000 units every 8 hr [3,[15][16]. Mechanical measures of prevention were recommended for those patients with an increased risk for bleeding.…”

Section: Interventionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates

et al. 2005

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Venous thromboembolism (VTE) is common but often unrecognized in medically ill patients. Over the past 5 years, three large-scale placebo-controlled trials enrolling a total of 5500 medically ill patients have highlighted the risk of VTE in this group. These trials have helped to define a specific at-risk patient profile, including those admitted to the hospital with severe congestive heart failure, respiratory illness, acute infection, and inflammatory bowel disease. We performed a retrospective review of patients admitted to the medical service at our tertiary care center to define how common the at-risk medical patient is and to evaluate and improve prophylaxis rates in this patient group. The study was conducted in two phases. Based on admission characteristics, patients were stratified into high-risk or low-risk groups for the development of VTE. During the pre-intervention phase, 75% of patients admitted to the medical service were characterized as increased risk for VTE, yet only 43% of these high-risk patients received prophylaxis of any sort. After interventions designed to increase awareness of VTE, we conducted a second review period. In this post-intervention phase, where 79% of patients were at risk for VTE, prophylaxis rates improved to 72%. Based on these results, we conclude that the majority of patients admitted to the medical service at our tertiary care center constitute a high-risk population that warrants consideration for VTE prophylaxis. Implementation of strategies to improve prophylaxis rates, including educational sessions and risk stratification guidelines, can be successful and improve identification and prophylaxis of this population. Am.

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Section: Interventionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates

et al. 2005

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“…23 In the subset of 245 patients with severe respiratory disease, the incidence of thromboembolic events was similar with enoxaparin treatment (7.1%) and LDUH treatment (5.9%). In the subset of 206 patients with heart failure, the incidence of thromboembolic events was lower with enoxaparin (9.7%) than with LDUH (16.1%).…”

mentioning

confidence: 88%

Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

Umland

2008

JMCP

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1 Most cases are asymptomatic; however, in approximately 600,000 cases, the thrombus embolizes and travels to the right atrium, through the right ventricle, and into the pulmonary arterial tree, lodging in the pulmonary vasculature. The mortality rate in patients with pulmonary embolism (PE) is high (approximately 10%), with nearly 60,000 deaths attributed to PE annually in the United States. Patients who survive PE may develop chronic pulmonary hypertension due to damage to the pulmonary vasculature. DVT can cause permanent damage to the valves of the venous system and may also result in post-thrombotic syndrome; chronic inflammation, edema, and pain; and, in severe cases, venous stasis ulcers of the lower extremities. ■■ PrevalenceVenous thromboembolism (VTE) risk factors are common among hospitalized patients. Using criteria established by the American College of Chest Physicians (ACCP) in their evidence-based guidelines for the prevention of VTE, review of a U.S. database containing more than 38 million inpatient discharge records showed that more than 12 million (31%) patients met the ACCP criteria for prophylaxis: 4.3 million surgical and 7.7 million medical patients.2,3 The larger number of medical patients at risk for VTE is significant because, although VTE risk is well recognized in surgical patients, the danger for medical patients is frequently underappreciated.While VTE is often considered to be a condition that develops primarily in elderly, bedridden hospital patients, recent medical record analysis provides a different picture. 4 A review of 1,897 VTE sufferers from Worcester, Massachusetts, showed that 74% of these patients developed VTE signs and symptoms as outpatients. The mean age of those 1,399 outpatients who developed VTE was 63 years, and 33% were aged < 55 years. In contrast, the mean age of the 498 inpatients who developed VTE was 67 years, with only 21% aged < 55 years. The presence of 5 VTE risk factors (recent hospitalization, recent surgery, active malignant neoplasm, recent infection, history of VTE) was ascertained in outpatients who developed VTE: 30% had no risk factors, 32% had 1, and 34% had 2-3. For patients who experienced VTE within 3 months after hospitalization (with or without surgery), two thirds experienced VTE within 1 month. The median and mean length of stay for this initial hospitalization was 4.0 and 7.4 days, respectively. It appears that an increased risk for VTE is present in the early post-discharge period after brief hospital stays for both medical and surgical patients.The risk of DVT without prophylaxis is 10%-20% in medical patients, 10%-80% for critical care patients, 20%-50% in patients ABSTRACT BACKGROUND: Venous thromboembolism (VTE) is a common and often preventable cause of morbidity and mortality in the United States, with a widespread economic impact.

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“…El estudio PRINCE estudió con distribución aleatoria 665 pacientes hospitalizados por insuficiencia cardiaca congestiva (Capacidad Funcional III/IV) o enfermedad respiratoria grave a recibir enoxaparina 40 mg al día o HNF 5.000 UI cada 8 horas. La heparina de bajo peso fue más efectiva reduciendo el riesgo de TVP (9,7% versus 16,1%) 30 . En suma, las HBPM son al menos tan efectivas como la HNF y parecen ser más seguras.…”

Section: Heparinas De Bajo Peso Molecular Versus Heparina No Fraccionadaunclassified

Profilaxis de enfermedad tromboembólica en pacientes hospitalizados con patología médica, estrechando la brecha entre las guías y la práctica clínica

2011

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Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease

Cited by 269 publications

References 0 publications

Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates

Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates

Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

Profilaxis de enfermedad tromboembólica en pacientes hospitalizados con patología médica, estrechando la brecha entre las guías y la práctica clínica

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