Patient selection for thromboprophylaxis in medical inpatients.

Acutely ill medical patients may be at increased risk of venous thromboembolism, both during hospitalization and after discharge. International guidelines recommend thromboprophylaxis for high-risk medical patients with low bleeding risk for a maximum of 14 days. There are two approaches to identify the high-risk patient: adhering to the inclusion criteria used in randomized clinical trials or using risk assessment models.

Novel oral anticoagulants for the prevention of venous thromboembolism in surgical patients.

Pharmacologic prophylaxis with low-dose unfractionated heparin, low molecular weight heparin or fondaparinux has clearly demonstrated to reduce the rate of thromboembolic events in surgical patients. In the last decade, several novel oral anticoagulants have been tested in surgical patients, but only in the setting of major orthopedic surgery. Based on the results of the studies, dabigatran, rivaroxaban and apixaban have been approved by the European Medicines Agency for the prevention of venous thromboembolism after elective hip or knee replacement surgery.

Thromboprophylaxis in surgical and medical patients.

Venous thromboembolism (VTE) remains the most common preventable cause of death in hospitalized patients. There is much evidence to show the efficacy of prophylactic strategies to prevent VTE in at-risk hospitalized patients. For example, pharmacological prophylaxis reduces the risk of pulmonary embolism by 75% in general surgical patients and by 57% in medical patients.

Fondaparinux for the treatment of superficial vein thrombosis in the legs: the CALISTO study.

Superficial vein thrombosis (SVT) is quite a common disease that is associated with a non-negligible risk of progression to the deep venous system and, in some cases, of embolization to the lungs. However, SVT has traditionally been regarded as a benign disease and its optimal management has been poorly studied. Recently, fondaparinux, a subcutaneous, selective, indirect Factor Xa inhibitor, has been assessed in the treatment of SVT in the CALISTO study, with encouraging results.

Prevalence of renal failure and use of antithrombotic prophylaxis among medical inpatients at increased risk of venous thromboembolic events.

Background: Evidence-based guidelines recommend the use of antithrombotic prophylaxis in medical patients at risk of venous thromboembolism (VTE). Low molecular weight heparins (LMWHs) are usually preferred to unfractionated heparin. However, when prophylactic doses of LMWH are administered, patients with renal failure (RF) are exposed to the risk of excessive accumulation, and thus to an increased risk of bleeding.