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Areas of uncertainty in prophylaxis of venous thromboembolism in unselected subjects.

Abstract
In the last decade, parenteral anticoagulants have proven to be effective in the prevention of venous thromboembolism (VTE) in patients admitted to hospitals. Despite this, some registry studies have shown that pharmacological prophylaxis is still widely underused. We performed a literature search to identify important knowledge gaps in the use of VTE prophylaxis that were not addressed by previous published reports. MEDLINE and HighWire databases covering the years 1999-2009 were searched; only clinical trials of unselected adult subjects were included. Two reviewers independently selected studies and extracted data on inclusion and exclusion criteria, age, weight, comorbidities, study designs, and endpoints. Five of 113 relevant studies were identified from the literature search. Knowledge gaps were disclosed in subject inclusion, exclusion, and stratification regarding young age, under- and overweight, comorbidities, and the selection of clinically significant endpoints. Uncertainties in the dosage, risk stratification of subjects, and effect on hard endpoints as prevention of pulmonary embolism or reduction of mortality reduce the impact of VTE prevention clinical trials.
AuthorsMarco Cei, Nicola Mumoli
JournalSouthern medical journal (South Med J) Vol. 104 Issue 11 Pg. 770-5 (Nov 2011) ISSN: 1541-8243 [Electronic] United States
PMID22024788 (Publication Type: Journal Article, Review)
Chemical References
  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Polysaccharides
  • Heparin
  • Fondaparinux
Topics
  • Anticoagulants (administration & dosage, therapeutic use)
  • Drug Administration Schedule
  • Fondaparinux
  • Heparin (administration & dosage, therapeutic use)
  • Heparin, Low-Molecular-Weight (administration & dosage, therapeutic use)
  • Hospitalization
  • Humans
  • Infusions, Parenteral
  • Polysaccharides (administration & dosage, therapeutic use)
  • Pulmonary Embolism (prevention & control)
  • Venous Thromboembolism (drug therapy, prevention & control)

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