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Peripheral Artery Disease: causes and consequences

Coronary Artery Disease: causes and consequences

Prevention of Venous Thromboembolism

This section examines thromboprophylaxis of VTE, including guideline recommendations and the benefits and risks of anticoagulant therapy, and other treatment options

Introduction

Routine preventive anticoagulant therapy – thromboprophylaxis – is an established standard of care for the prevention of VTE in patients who have had major orthopaedic surgery.1

  • Thromboprophylaxis has also proven to be cost-effective in moderate- and high-risk general surgery patients
  • In acutely ill, hospitalized medical patients, pharmacological prophylaxis is also recommended, although the optimal duration of therapy is not well defined2

Despite the well-recognized risks of VTE, use of appropriate prophylaxis remains low. A multinational, cross-sectional audit including 32 countries – the ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) survey – showed that:3,4

  • 64% of surgical patients were at risk of VTE, but only just over half of these received recommended prophylaxis
  • Only 39.5% of at-risk medical patients received recommended prophylaxis
  • Only half all the patients considered to be at risk of VTE received appropriate thromboprophylaxis, although this varied between countries
VTE-risk-ENDORSE

Proportions of patients (A) at risk of VTE and (B) receiving recommended prophylaxis.
Data from the ENDORSE survey3

References
  • Kakkar AK. Prevention of venous thromboembolism in general surgery. In Hemostasis and Thrombosis: Basic Principles and Clinical Practice. 5th edn. Colman RW, Clowes AW, George JN et al. (editors). Philadelphia: Lippincott, Williams & Wilkins; 2006. p. 1361–1367. Return to content
  • Kahn SR, Lim W, Dunn AS et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e195S–e226S. Return to content
  • Cohen AT, Tapson VF, Bergmann JF et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008;371:387–394. Return to content
  • Bergmann JF, Cohen AT, Tapson VF et al. Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey. Thromb Haemost 2010;103:736–748. Return to content

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