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Thromboprophylaxis with dalteparin in medical patients: which patients benefit?

Cohen, A. T.; Turpie, A. G. G.; Leizorovicz, A.; Olsson, Carl-Gustav LU ; Vaitkus, P. T.; Goldhaber, S. Z. and Stu, Prevent Med Thromboprophylaxis (2007) In Vascular Medicine 12(2). p.123-127
Abstract
It is unclear whether thromboprophylaxis produces a consistent risk reduction in different subgroups of medical patients at risk from venous thromboembolism. We performed a retrospective, post hoc analysis of 3706 patients enrolled in the PREVENT study. Patients were at least 40 years old with an acute medical condition requiring hospitalization for at least 4 days and had no more than 3 days of immobilization prior to enrolment. Patients received either subcutaneous dalteparin (5000 IU) or placebo once daily. The primary end point was the composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism, asymptomatic proximal DVT or sudden death. Primary diagnosis subgroups were acute congestive heart failure, acute respiratory... (More)
It is unclear whether thromboprophylaxis produces a consistent risk reduction in different subgroups of medical patients at risk from venous thromboembolism. We performed a retrospective, post hoc analysis of 3706 patients enrolled in the PREVENT study. Patients were at least 40 years old with an acute medical condition requiring hospitalization for at least 4 days and had no more than 3 days of immobilization prior to enrolment. Patients received either subcutaneous dalteparin (5000 IU) or placebo once daily. The primary end point was the composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism, asymptomatic proximal DVT or sudden death. Primary diagnosis subgroups were acute congestive heart failure, acute respiratory failure, infectious disease, rheumatological disorders, or inflammatory bowel disease. All patients, except those with congestive heart or respiratory failure, had at least one additional risk factor for venous thromboembolism. A risk reduction was shown in patients receiving dalteparin versus placebo. The relative risk (RR) was 0.73 in patients with congestive heart failure, 0.72 for respiratory failure, 0.46 for infectious disease, and 0.97 for rheumatological disorders. The RR was 0.52 in patients aged >= 75 years, 0.64 in obese patients, 0.34 for patients with varicose veins, and 0.71 in patients with chronic heart failure. No subgroup had a significantly different response from any other. Importantly, multivariate analysis showed that all patient groups benefited from thromboprophylaxis with dalteparin. Our findings, therefore, support the broad application of thromboprophylaxis in acutely ill hospitalized medical patients. (Less)
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keywords
PULMONARY-EMBOLISM, SUBGROUP ANALYSIS, RISK-FACTORS, PREVENTION, EFFICACY, TRIAL, ILL, ENOXAPARIN, DEEP-VEIN THROMBOSIS, VENOUS THROMBOEMBOLISM, low-molecular-weight, dalteparin, deep vein thrombosis, thromboembolism, anticoagulants, heparin
in
Vascular Medicine
volume
12
issue
2
pages
123 - 127
publisher
SAGE Publications Inc.
external identifiers
  • wos:000247470400004
  • scopus:34347237637
ISSN
1477-0377
DOI
10.1177/1358863x07079017
language
English
LU publication?
yes
id
e2295745-e83c-4116-937d-5ab3589dd51f (old id 1416387)
date added to LUP
2009-06-16 16:12:34
date last changed
2017-09-24 03:33:00
@article{e2295745-e83c-4116-937d-5ab3589dd51f,
  abstract     = {It is unclear whether thromboprophylaxis produces a consistent risk reduction in different subgroups of medical patients at risk from venous thromboembolism. We performed a retrospective, post hoc analysis of 3706 patients enrolled in the PREVENT study. Patients were at least 40 years old with an acute medical condition requiring hospitalization for at least 4 days and had no more than 3 days of immobilization prior to enrolment. Patients received either subcutaneous dalteparin (5000 IU) or placebo once daily. The primary end point was the composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism, asymptomatic proximal DVT or sudden death. Primary diagnosis subgroups were acute congestive heart failure, acute respiratory failure, infectious disease, rheumatological disorders, or inflammatory bowel disease. All patients, except those with congestive heart or respiratory failure, had at least one additional risk factor for venous thromboembolism. A risk reduction was shown in patients receiving dalteparin versus placebo. The relative risk (RR) was 0.73 in patients with congestive heart failure, 0.72 for respiratory failure, 0.46 for infectious disease, and 0.97 for rheumatological disorders. The RR was 0.52 in patients aged >= 75 years, 0.64 in obese patients, 0.34 for patients with varicose veins, and 0.71 in patients with chronic heart failure. No subgroup had a significantly different response from any other. Importantly, multivariate analysis showed that all patient groups benefited from thromboprophylaxis with dalteparin. Our findings, therefore, support the broad application of thromboprophylaxis in acutely ill hospitalized medical patients.},
  author       = {Cohen, A. T. and Turpie, A. G. G. and Leizorovicz, A. and Olsson, Carl-Gustav and Vaitkus, P. T. and Goldhaber, S. Z. and Stu, Prevent Med Thromboprophylaxis},
  issn         = {1477-0377},
  keyword      = {PULMONARY-EMBOLISM,SUBGROUP ANALYSIS,RISK-FACTORS,PREVENTION,EFFICACY,TRIAL,ILL,ENOXAPARIN,DEEP-VEIN THROMBOSIS,VENOUS THROMBOEMBOLISM,low-molecular-weight,dalteparin,deep vein thrombosis,thromboembolism,anticoagulants,heparin},
  language     = {eng},
  number       = {2},
  pages        = {123--127},
  publisher    = {SAGE Publications Inc.},
  series       = {Vascular Medicine},
  title        = {Thromboprophylaxis with dalteparin in medical patients: which patients benefit?},
  url          = {http://dx.doi.org/10.1177/1358863x07079017},
  volume       = {12},
  year         = {2007},
}