In this meta-analysis of randomized trials of medical patients on VTE prophylaxis, those on heparin products (vs none) had no significant reduction in mortality, symptomatic DVT, or fatal PE, but did have a significant 31% reduction in PE, and a significant 34% increase in bleeding events. There were no differences in any of the outcomes between LMWH or UFH. Mechanical prophylaxis did not reduce mortality, DVT, or PE (compared to no prophylaxis) but was associated with a 4-fold increase in skin damage. In stroke patients, they found no benefit, but significant increases in the risk of bleeding. This study calls into question the ubiquitous use of VTE prophylaxis in all medical patients; a tailored approach based on risk of VTE and risk of bleeding is preferred, and mechanical prophylaxis is unlikely to be beneficial at all (abstract).
I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how […]
As you can see, no glamour shots for this month’s post. I knew it would come at some point, and my first hospitalization related to my CLL came in a big way in mid-July. Given my interest in global health, it was only fitting that I managed to get sick while out of the […]
This large multicenter trial randomized patients with acute VTE to apixaban (10mg BID for 1 week, followed by 5mg BID for 6 months) versus conventional therapy (lovenox-warfarin). The primary outcome was similar between groups (symptomatic VTE or death related to VTE), but major and minor bleeding occurred significantly less often with apixaban. Apixaban is a […]