Unmet definitions in thromboprophylaxis for hospitalized medical patients: An appraisal for the need of recommendation

Abstract

Up to about 60% of venous thromboembolic events in a community are associated with hospitalization, and most can be prevented by appropriate thromboprophylaxis. Several randomized clinical trials and guidelines have addressed the issue of thromboprophylaxis in hospitalized patients and recommended strategies to assess patients' risk and thromboprophylaxis. Simple and validated risk assessment models are available to assist physicians in selecting patients who are at high risk for VTE, in whom thromboprophylaxis should be used. However, some concepts employed are imprecise or not appropriately defined. Indeed, there has been wide variation in the onset, duration, and adequacy of thromboprophylaxis, as well as in the definition of some risk factors. In this article, we highlight these issues and the unmet definitions in thromboprophylaxis in hospitalized patients mainly by addressing selected randomized clinical trials and guidelines.

Limitations of venous thromboembolism risk assessment models in medical patients: Response to “Unmet definitions in thromboprophylaxis for hospitalized medical patients: An appraisal for the need of recommendation”

“…We agree with Ávila Ferreira et al. [ 1 ] that mobility assessment in patients can be challenging and subjective given the different definitions of reduced mobility and the timing of assessment of mobility. Initial postadmission assessment of mobility is generally used; however, mobility may deteriorate throughout the course of admission.…”

“…We agree with you that both PPS and the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score have modest ability to predict the risk of VTE [ 1 ]. However, the Medically Ill Patient Assessment of Rivaroxaban versus Placebo in Reducing Post-Discharge Venous Thrombo-Embolism Risk (MARINER) study applied a modified IMPROVE risk score to identify medical patients who may benefit from extended thromboprophylaxis [ 9 ].…”

“…We read with interest the recent review of Ferreira and colleagues describing imprecise and unclear areas in thromboprophylaxis for hospitalized medical patients [ 1 ]. However, we consider that there are other important uncertainties in this field, particularly in relation to limitations of available risk assessment models (RAMs).…”

A need to refine venous thromboembolism risk assessment: the challenge of optimizing patient selection for thromboprophylaxis among hospitalized adults

“…Unfortunately prophylaxis decisions can still be challenging, even if using one of over a dozen RAMs available to guide risk-adapted prophylaxis decisions [ 11 ]. The operationalization and definition of VTE risk factors used in RAMs, like immobility, is variable [ 12 ]. Furthermore, what constitutes “adequate,” “appropriate,” “overuse,” and “underuse” of prophylaxis is not broadly agreed upon [ 7 ].…”