The case for extended thromboprophylaxis in medically hospitalised patients

Abstract

Background

The role of extended thromboprophylaxis is established for surgical patients, but not yet for hospitalised medical patients.

Design

This systematic review and meta-analysis sought to explore the role of extended thromboprophylaxis for medically ill hospitalised patients.

Methods

Medline, EMBASE and Cochrane Libraries were searched and five randomised controlled trials were identified, comprising 20,046 extended and 20,078 standard duration thromboprophylaxis patients.

Results

Allocation to extended treatment, compared with standard duration therapy, significantly reduced the risk of symptomatic deep vein thrombosis (relative risk (RR) 0.47, 95% confidence interval (CI) 0.29–0.78, P = 0.003) and non-fatal pulmonary embolism (RR 0.59, 95% CI 0.39–0.91, P = 0.02). The risk of venous thromboembolism-related death was comparable between the extended and standard duration treatment groups (RR 0.81, 95% CI 0.6–1.09, P = 0.16). Extended treatment also doubled the risk of major bleeding (RR 2.04, 95% CI 1.42–2.91, P < 0.001), without significantly affecting the risk of intracranial bleeding or bleeding-associated death. The cost of preventing one symptomatic deep vein thrombosis and non-fatal pulmonary embolism was found to be £24,972 (€27,969) and £45,148 (€50,566), respectively, which outweigh the direct cost of managing established venous thromboembolism as previously reported.

Conclusions

Extended duration thromboprophylaxis caused a reduction in the risk of venous thromboembolic events, but also a numerically comparable increase in major bleeding. Further trials are required in high-risk subpopulations who may derive mortality benefits from treatment. Only then could a change in current policy and practice be supported.

Keywords

Thromboprophylaxis venous thromboembolism cost analysis

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The case for extended thromboprophylaxis in medically hospitalised patients – not yet made

Abstract

Background

Design

Methods

Results

Conclusions

Keywords

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References

Supplementary Material