Extended VTE prophylaxis in surgical patients is beneficial, but the appropriate duration of VTE prophylaxis in medical inpatients is unknown. In this large multi-national industry-sponsored trial, acutely ill medical patients >age 40 with limited mobility (bedrest OR bathroom privileges with another VTE risk factor) were randomized to enoxaparin 40mg/day for a month (after open label enoxaparin for 10-14 days). Extended VTE prophylaxis significantly reduced the risk of VTE (2.5% vs 4%), but at the expense of higher rates of bleeding (0.8% vs 0.3%). The subgroups that benefitted the most from extended prophylaxis were women, those >age 75, and those on bedrest (abstract). There was no benefit for extended prophylaxis in those with bathroom privileges, unless they had another VTE risk factor (age >75, cancer, or history of VTE).
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 […]