Extended-Duration Thromboprophylaxis Among Acute Medically Ill Patients: An Unmet Need.
Acute medical illnesses are associated with a prolonged elevation in inflammatory markers that predisposes patients to thrombosis beyond the duration of their hospital stay. In parallel, both observational and randomized data have demonstrated a rate of postdischarge venous thromboembolic events that often exceeds that observed in the hospital setting. Despite this significant residual risk of venous thromboembolic events following discharge among acute medically ill patients, no therapeutic strategies have been recommended to address this unmet need. Available randomized trials have demonstrated the efficacy of extending the duration of thromboprophylaxis with available anticoagulants; however, the efficacy is offset, at least in part, by an increase in bleeding events. Identification of the optimal therapeutic strategies, treatment duration, and risk assessment tools that reconcile both efficacy and safety of extended-duration thromboprophylaxis among acute medically ill patients is an area of ongoing investigation.
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Serge
S
Korjian
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Yazan
Y
Daaboul
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Rim
R
Halaby
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Samuel Z
SZ
Goldhaber
Department of Haematology, Guys and St Thomas' NHS Trust, London, United Kingdom.
Alexander T
AT
Cohen
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Kiran
K
Singh
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Ammu T
AT
Susheela
Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Robert A
RA
Harrington
Department of Medicine, Foothills Hospital, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Russell D
RD
Hull
Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Adrian F
AF
Hernandez
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA mgibson@bidmc.harvard.edu.
C Michael
CM
Gibson
D000208:Acute Disease; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D061214:Patient Safety; D011655:Pulmonary Embolism / Q000097:blood / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000097:blood / Q000191:economics / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D005343:Fibrinolytic Agents
acute medically ill; anticoagulation; deep vein thrombosis; pulmonary embolism; thromboprophylaxis; venous thromboembolism