Wednesday, October 13, 2010

Extended duration VTE prophylaxis in medical patients

Extended duration (post hospital) VTE prophylax in medical patients is is controversial and difficult to implement. This RCT suggests that it is beneficial only in selected patients:

Results: Extended-duration enoxaparin reduced VTE incidence compared with placebo (2.5% vs. 4%; absolute risk difference favoring enoxaparin, −1.53% [95.8% CI, −2.54% to −0.52%]). Enoxaparin increased major bleeding events (0.8% vs. 0.3%; absolute risk difference favoring placebo, 0.51% [95% CI, 0.12% to 0.89%]). The benefits of extended-duration enoxaparin seemed to be restricted to women, patients older than 75 years, and those with level 1 immobility.

Conclusion: Use of extended-duration enoxaparin reduces VTE more than it increases major bleeding events in acutely ill medical patients with level 1 immobility, those older than 75 years, and women.

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