Bayer Pharma AG

Preventable venous thromboembolism in medically ill patients

Preventable venous thromboembolism in medically ill patients

Medical illness and hospitalization increase the risk of developing venous thromboembolism, which, along with associated complications, leads to poorer patient outcomes and an increased healthcare burden. Thromboprophylaxis significantly reduces the risk of venous thromboembolism in acutely ill medical patients, and current guidelines recommend that unfractionated heparin, low molecular weight heparin or fondaparinux should be administered for the duration of hospitalization or immobilization. Other guidelines advise thromboprophylaxis with these agents for up to 14 days. Despite this guidance, many patients do not receive adequate thromboprophylaxis. Furthermore, the duration of recommended prophylaxis may not be sufficient to ensure protection while patients are at risk of venous thromboembolic events.


Preventing venous thromboembolism in medically ill patients: ongoing phase III studies

Although Factor Xa inhibitors have been investigated for the prevention of venous thromboembolism in acutely ill medical patients, the demonstration of a favourable benefit–risk profile has proved challenging. Large phase III clinical trials investigating the clinical outcomes of rivaroxaban and betrixaban in this patient population are ongoing.


Thromboprophylaxis in medically ill patients: recent phase III studies

Short-term thromboprophylaxis is recommended in acutely ill medical patients to reduce the risk of developing venous thromboembolism during hospitalization. Although thromboprophylaxis after major orthopaedic surgery is recommended post-discharge, this is not the case for medically ill patients, in whom thromboprophylaxis is recommended only for the duration of hospitalization or immobilization (or for up to 14 days in some guidelines). Therefore, patients may continue to be at risk of venous thromboembolic events for weeks or months after hospitalization. The benefit of thromboprophylaxis with direct Factor Xa inhibitors and direct thrombin inhibitors after elective hip or knee replacement surgery is now well established; however, it has been more difficult to identify from clinical studies groups of medically ill patients who would benefit from extended thromboprophylaxis.