The case for extended thromboprophylaxis in medically hospitalised patients - not yet made.
Eur J Prev Cardiol
; 28(11): 1167-1174, 2021 09 20.
Article
em En
| MEDLINE
| ID: mdl-37039763
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Systematic_reviews
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article