Prophylaxis of venous thrombosis in medical patients : a real-world perspective : cardiovascular topics
2006
Background: Although low-molecular weight heparins
(LMWH) have been proven to be efficacious for prophylaxis
of venous thrombo-embolism (VTE) in non-surgical
patients, their use and safety outside the setting of a clinical
trial has not been investigated.
Objective: The objective of this survey was to determine
the efficacy and safety of LMWH (enoxaparin) in the
prevention of VTE in a study population comprising
general medical patients.
Methods: The study involved an open-label, non-controlled,
multicentre survey of any patient confined to bed
due to medical illness, where the physician had made an
independent decision to prescribe LMWH as prophylaxis
for VTE. The demographic information and risk factors
for venous thrombosis and dose of enoxaparin were
recorded. Patients were assessed for clinical evidence
of VTE. Only if this was present were further invasive
investigations performed. Adverse events relating to the
use of LMWH were recorded.
Results: Four hundred and seventy-one patients were
enrolled from 53 centres. Five per cent of the patients
were treated for up to and including three days, 24.4%
for four days or less, 49.6% for six days or less, and a
further 45.5 % for seven to 21 days. The most frequently
prescribed dose was enoxaparin 40 mg once daily (86%).
Of the enrolled patients, 28.2% had one risk factor and
69.8% had two or more risk factors for the development
of VTE. The incidence of clinically suspected deep-vein
thrombosis (DVT) or pulmonary embolism (PE) in this
survey was three out of 457 patients at risk, ie, 0.66%.
One serious adverse event occurred in an incorrectly
enrolled surgical patient and 22 minor adverse events
occurred that were thought by the enrolling physician to
be related to the study drug.
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