title: Venous thromboembolism prophylaxis with anticoagulation in septic patients: a prospective cohort study.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a feared complication during hospitalization. The practice of administering pharmacological prophylaxis is highly endorsed despite failure of studies to show reduction in mortality.
  
  
  OBJECTIVE
  : To determine the benefit of VTE prophylaxis in acutely ill medical patients with sepsis.
  
  
  METHODS
  A prospective cohort, with enrollment between January 2010 and April 2011. Patients were detected in four medicine departments at a university-affiliated hospital and followed for 90 days for pre-specified outcomes. We included all septic patients at high VTE risk defined by Padua score ≥ 4. The primary outcome was 30-day mortality. Incidence of pulmonary embolism, deep vein thrombosis or major bleeding episodes at 30 and 90 days, and 90-day mortality were secondary outcomes.
  
  
  RESULTS
  A total of 1540 patients were identified, of which 720 (55%) were at high risk for VTE and included. A total of 213 (29.6%) patients received prophylaxis. VTE occurred in 6 control patients and 2 treated (0.9 and 1.2%, respectively, RR 0.79, CI: 0.16-3.95). Major bleeding events occurred in 4 (0.8%) control and 7 (3.3%) treated patients (RR 4.1, CI: 1.24-14.08, P = 0.01). After adjusting for covariates, VTE prophylaxis conferred no 30- or 90-day mortality benefit (OR 1.24, CI: 0.79-1.93 and OR 1.47, CI: 0.99-2.17, respectively). Lack of significant benefit with prophylaxis persisted after propensity-score matching (OR for 30-day mortality 1.01, CI: 0.66-1.55).
  
  
  CONCLUSIONS
  In acutely ill inpatients with sepsis, no significant benefit was demonstrated for VTE prophylaxis, with higher rates of bleeding. The risk-benefit ratio of this intervention should be carefully examined.
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel orenzu1@clalit.org.il.
authors.forename: O
authors.initials: O
authors.lastname: Zusman
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Farbman
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: V
authors.initials: V
authors.lastname: Daitch
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Akayzen
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Witberg
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Avni
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel From the Department of Medicine E, Rabin Medical Center, Petach-Tikva, Israel, Infectious Disease Unit, Rambam Medical Center, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Leibovici
mesh_terms: D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants