Prior thromboprophylaxis and outcome in patients experiencing acute venous thromboembolism after an acute medical illness

  • Adel Merah
    Correspondence
    Corresponding author at: Department of Vascular Medicine and Therapeutics, Hôpital Nord–CHU St-Etienne, Saint-Etienne F-42055, France. Tel.: +33 477127592; fax: +33 477120482.
    Affiliations
    INSERM, CIC1408, Saint-Etienne F-42055, France

    INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne F-42055, France

    CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne F-42055, France

    GIRC-Thrombose–INNOVTE network, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France
    Search for articles by this author
  • Laurent Bertoletti
    Affiliations
    INSERM, CIC1408, Saint-Etienne F-42055, France

    INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne F-42055, France

    CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne F-42055, France

    GIRC-Thrombose–INNOVTE network, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne F-42055, France
    Search for articles by this author
  • Mouzayan Ginzarly
    Affiliations
    INSERM, CIC1408, Saint-Etienne F-42055, France

    CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, Saint-Etienne F-42055, France
    Search for articles by this author
  • David Zeltser
    Affiliations
    Department of Internal Medicine, Tel Aviv Soursky Medical Center, Tel Aviv, Israel
    Search for articles by this author
  • Manuel Barrón
    Affiliations
    Department of Pneumonology, Hospital San Pedro, Logroño, La Rioja, Spain
    Search for articles by this author
  • Inmaculada Cañas
    Affiliations
    Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
    Search for articles by this author
  • Jaume Villalta
    Affiliations
    Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
    Search for articles by this author
  • Eugenio Bucherini
    Affiliations
    Department of Vascular Medicine, Azienda U.S.L. Di Ravenna–O.C. Di Faenza, Ravenna, Italy
    Search for articles by this author
  • Manuel Monreal
    Affiliations
    Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Spain
    Search for articles by this author
  • on behalf of the RIETE investigators
    Author Footnotes
    1 A full list of RIETE investigators is given in the appendix.
  • Author Footnotes
    1 A full list of RIETE investigators is given in the appendix.
Published:March 11, 2016DOI:https://doi.org/10.1016/j.ejim.2016.02.022

      Highlights

      • Thromboprophylaxis decreases the VTE risk.
      • Patients may present VTE despite prevention.
      • Their prognosis is not worse than the others.

      Abstract

      Background

      Even despite the use of thromboprophylaxis, some patients with an acute medical illness develop symptomatic venous thromboembolism (VTE). It is unclear whether the outcome in these patients is different in those in whom prophylaxis was not prescribed.

      Patients and methods

      We used the RIETE (Registro Informatizado Enfermedad TromboEmbolica) database to compare the 3-month outcome (death, fatal pulmonary embolism, VTE recurrences, major bleeding) of patients with acute VTE after immobilization for an acute medical disease, according to the use of prophylaxis.

      Results

      Thromboprophylaxis was prescribed in 1313 (37%) of the 3527 patients included in August 2014. Acute infection was the most frequent cause of immobilization. Patients who received prophylaxis were more frequently immobilized in hospital than at home (70% vs. 22%), and fewer patients were immobilized for cancer (13% vs. 22%). During the first 3 months of treatment, the rates of all-cause death (23 vs. 21%), fatal PE (2.6 vs. 3.1%), VTE recurrences (2.4% vs. 2.8%), and major bleeding (4.2% for both) did not differ between the two groups. Thromboprophylaxis was not associated with each outcome in multivariate analysis.

      Conclusions

      The outcome in patients with VTE provoked by medical immobilization was not influenced by the use of thromboprophylaxis during the period of immobility.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Kearon C.
        • Akl E.a
        • Comerota A.J.
        • et al.
        Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141: e419S-e494Shttps://doi.org/10.1378/chest.11-2301
        • Cohen A.T.
        • Agnelli G.
        • Anderson F.A.
        • et al.
        Venous thromboembolism (VTE) in Europe.
        Thromb Haemost. 2007; 98: 756-764https://doi.org/10.1160/TH07
        • Samama M.M.
        • Cohen A.T.
        • Darmon J.Y.
        • et al.
        A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. The MEDENOX Study.
        N Engl J Med. 1999; 341: 793-800https://doi.org/10.1056/NEJM199909093411103
        • Leizorovicz A.
        • Cohen A.T.
        • Turpie A.G.G.
        • Olsson C.-G.
        • Vaitkus P.T.
        • Goldhaber S.Z.
        Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients.
        Circulation. 2004; 110: 874-879https://doi.org/10.1161/01.CIR.0000138928.83266.24
        • Cohen A.T.
        • Davidson B.L.
        • Gallus A.S.
        • et al.
        Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial.
        BMJ. 2006; 332: 325-329https://doi.org/10.1136/bmj.38733.466748.7C
        • Kakkar A.K.
        • Cimminiello C.
        • Goldhaber S.Z.
        • Parakh R.
        • Wang C.
        • Bergmann J.-F.
        Low-molecular-weight heparin and mortality in acutely ill medical patients.
        N Engl J Med. 2011; 365: 2463-2472https://doi.org/10.1056/NEJMoa1111288
        • Leizorovicz A.
        • Mismetti P.
        Preventing venous thromboembolism in medical patients.
        Circulation. 2004; 110: IV13-IV19https://doi.org/10.1161/01.CIR.0000150640.98772.af
        • Agency for Healthcare Research and Quality, Rockville M. Care Delivery for Preventing Hospital-Acquired Venous Thromboembolism
        Chapter 1. Take Essential First Steps.
        (Available at:) ([Accessed November 8, 2015])
        • Bosson J.-L.
        • Pouchain D.
        • Bergmann J.-F.
        A prospective observational study of a cohort of outpatients with an acute medical event and reduced mobility: incidence of symptomatic thromboembolism and description of thromboprophylaxis practices.
        J Intern Med. 2006; 260: 168-176https://doi.org/10.1111/j.1365-2796.2006.01678.x
        • Monreal M.
        • Muñoz-Torrero J.F.S.
        • Naraine V.S.
        • et al.
        Pulmonary embolism in patients with chronic obstructive pulmonary disease or congestive heart failure.
        Am J Med. 2006; 119: 851-858https://doi.org/10.1016/j.amjmed.2005.11.035
        • Trujillo-Santos J.
        • Schellong S.
        • Falga C.
        • et al.
        Low-molecular-weight or unfractionated heparin in venous thromboembolism: the influence of renal function.
        Am J Med. 2013; 126 ([e1.]): 425-434https://doi.org/10.1016/j.amjmed.2012.09.021
        • Trujillo-Santos J.
        • Lozano F.
        • Lorente M.A.
        • et al.
        A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs.
        Am J Med. 2015; 128: 90.e9-90.e15https://doi.org/10.1016/j.amjmed.2014.08.023
        • Muriel A.
        • Jiménez D.
        • Aujesky D.
        • et al.
        Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk.
        J Am Coll Cardiol. 2014; https://doi.org/10.1016/j.jacc.2014.01.058
        • Schulman S.
        • Kearon C on behalf of the subcommittee on control of anticoagulation of the S and S, Haemostasis committee of the IS on T and
        Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.
        J Thromb Haemost. 2005; 3: 692-694
        • Nauffal D.
        • Ballester M.
        • Reyes R.L.
        • et al.
        Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism.
        J Thromb Haemost. 2012; 10: 1752-1760https://doi.org/10.1111/j.1538-7836.2012.04829.x
        • Cohen A.T.
        • Tapson V.F.
        • Bergmann J.-F.
        • et al.
        Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study.
        Lancet. 2008; 371: 387-394https://doi.org/10.1016/S0140-6736(08)60202-0
        • Frasson S.
        • Gussoni G.
        • Di Micco P.
        • et al.
        Infection as cause of immobility and occurrence of venous thromboembolism: analysis of 1635 medical cases from the RIETE registry.
        J Thromb Thrombolysis. 2015; https://doi.org/10.1007/s11239-015-1242-2
        • Decousus H.
        • Tapson V.F.
        • Bergmann J.F.
        • et al.
        Factors at admission associated with bleeding risk in medical patients: findings from the improve investigators.
        Chest. 2011; 139: 69-79https://doi.org/10.1378/chest.09-3081
        • Department of Health And Human Services
        Hospital-Acquired Conditions (Present on Admission Indicator).
        Centers Medicare Medicaid Serv, 2014 ([Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html?redirect=/HospitalAcqCond. Accessed October 8, 2015])
        • Mahé I.
        • Daurès J.-P.
        • Pouchain D.
        • et al.
        Prevention of venous thromboembolic events by fondaparinux 2.5 mg in general practice. ArchiMed Ville.
        J Mal Vasc. 2015; https://doi.org/10.1016/j.jmv.2015.06.004