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Thromb Haemost 2010; 104(05): 955-961
DOI: 10.1160/TH10-04-0236
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Does ambulation modify venous thromboembolism risk in acutely ill medical patients?

Alpesh N. Amin
1   University of California-Irvine, Orange, California, USA
,
Frederick Girard
2   sanofi-aventis, Bridgewater, New Jersey, USA
,
Meyer M. Samama
3   Hotel Dieu University Hospital, Paris, France
› Institutsangaben Financial support: The authors received editorial/writing support in the preparation of this manuscript funded by sanofi-aventis U.S., Inc. The authors are fully responsible for all content and editorial decisions and received no financial support or other form of compensation related to the development of the manuscript.
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Publikationsverlauf

Received: 16. April 2010

Accepted after major revision: 02. Juli 2010

Publikationsdatum:
24. November 2017 (online)

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Summary

In the US, ambulatory status is often a criterion for stopping prophylaxis for venous thromboembolism (VTE). In an analysis of the prophylaxis in MEDical patients with ENOXaparin (MEDENOX) trial, ambulatory status was assessed as outcome and patients grouped accordingly for further analysis. Rates of VTE and bleeding were evaluated. Using multivariate logistic regression, the relationships between thromboprophylaxis, VTE risk, and ambulatory status were assessed. Ambulatory status was reached in 607/1,084 patients, in a mean time of 4.4 days. Thromboprophylaxis was provided for 7.3 and 7.7 days in the ambulatory and non-ambulatory groups. Although VTE rates were lower in ambulatory patients, enoxaparin 40 mg once daily significantly reduced the risk of VTE vs. placebo in ambulatory (3.3% vs. 10.6%; relative risk [RR] = 0.31; 95% confidence interval [CI], 0.13ﺹ0.78; p=0.008) and non-ambulatory patients (9.0% vs. 19.7%; RR = 0.46; 95% CI, 0.23ﺹ0.91; p=0.02). Major bleeding was not significantly different between enoxaparin and placebo in either group. By multivariate regression analysis, VTE risk in ambulatory patients was lower with enoxaparin vs. placebo (odds ratio [OR] = 0.28; 95% CI, 0.11ﺹ0.74; p=0.01), but higher in patients with a history of VTE (OR = 3.74; 95% CI, 1.59ﺹ8.84; p=0.003) or cancer (OR = 2.12; 95% CI, 1.00ﺹ4.48; p=0.049). Despite timely mobilisation, patients who become ambulatory are at VTE risk and experience a significant risk reduction with enoxaparin 40 mg. Therefore, it is essential that ambulatory patients receive recommended thromboprophylaxis.

Keywords

Ambulation - enoxaparin - thromboprophylaxis - venous thromboembolism
 

  • References

  • 1 Gerotziafas GT, Samama MM. Prophylaxis of venous thromboembolism in medical patients. Curr Opin Pulm Med 2004; 10: 356-365.
    CrossrefPubMedGoogle Scholar
  • 2 Deitelzweig S, Lin J, Johnson BH. et al. Prevalence of venous thromboembolism (VTE) in the USA: now and future [abstract OC-WE-018]. J Thromb Haemost 2009; 07 (Suppl. 02) 207-208.
    PubMedGoogle Scholar
  • 3 Piazza G, Fanikos J, Zayaruzny M. et al. Venous thromboembolic events in hospitalised medical patients. Thromb Haemost. 2009; 102: 505-510.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Amin AN, Deitelzweig SB. Optimizing the prevention of venous thromboembolism: recent quality initiatives and strategies to drive improvement. Jt Comm J Qual Patient Saf 2009; 35: 558-564.
    PubMedGoogle Scholar
  • 5 Bergmann JF, Cohen AT, Tapson VF. et al ENDORSE Investigators.. Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey. Thromb Haemost. 2010; 103: 736-748.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 6 Samama MM, Cohen AT, Darmon JY. et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med 1999; 341: 793-800.
    CrossrefPubMedGoogle Scholar
  • 7 Leizorovicz A, Cohen AT, Turpie AG. et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110: 874-879.
    CrossrefPubMedGoogle Scholar
  • 8 Cohen AT, Davidson BL, Gallus AS. et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. Br Med J 2006; 332: 325-329.
    CrossrefPubMedGoogle Scholar
  • 9 2005 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. Report # 2008–01. Rockville, MD, Agency for Healthcare Research and Quality, US Department of Health and Human Services; February 22, 2008. Available at: http://www.hcup-us.ahrq.gov/reports/2008_01.pdf Accessed September 29, 2009.
    PubMedGoogle Scholar
  • 10 Ham C, York N, Sutch S. et al. Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. Br Med J 2003; 327: 1257.
    CrossrefPubMedGoogle Scholar
  • 11 DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat 2007; 13: 1-209.
    PubMedGoogle Scholar
  • 12 Yu HT, Dylan ML, Lin J. et al. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm 2007; 64: 69-76.
    CrossrefPubMedGoogle Scholar
  • 13 Amin A, Lin J, Ryan A. VTE prophylaxis across the continuum of care in US medical patients at risk of venous thromboembolism [Abstract]. Blood 2009; 114: 1386.
    PubMedGoogle Scholar
  • 14 Turpie AG, Chin BS, Lip GY. Venous thromboembolism: pathophysiology, clinical features, and prevention. Br Med J 2002; 325: 887-890.
    CrossrefPubMedGoogle Scholar
  • 15 Alikhan R, Cohen AT, Combe S. et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis 2003; 14: 341-346.
    CrossrefPubMedGoogle Scholar
  • 16 Amin AN, Stemkowski S, Lin J. et al. Inpatient thromboprophylaxis use in U.S. hospitals: adherence to the seventh American College of Chest Physician’s recommendations for at-risk medical and surgical patients. J Hosp Med 2009; 04: E15-21.
    PubMedGoogle Scholar
  • 17 Pottier P, Hardouin JB, Lejeune S. et al. Immobilization and the risk of venous thromboembolism. A meta-analysis on epidemiological studies. Thromb Res 2009; 124: 468-476.
    CrossrefPubMedGoogle Scholar
  • 18 Vasco B, Villalba JC, Lopez-Jimenez L. et al RIETE Investigators.. Venous thromboembolism in nonagenarians. Findings from the RIETE Registry. Thromb Haemost 2009; 101: 1112-1118.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Spyropoulos AC, Hussein M, Lin J. et al. Rates of venous thromboembolism occurrence in medical patients among the insured population. Thromb Haemost 2009; 102: 951-957.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 Paneesha S, McManus A, Arya R. et al. VERITY Investigators.. Frequency, demographics and risk (according to tumour type or site) of cancer-associated thrombosis among patients seen at outpatient DVT clinics. Thromb Haemost 2010; 103: 338-343.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 21 Vaitkus PT, Leizorovicz A, Cohen AT. et al. Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients. Thromb Haemost 2005; 93: 76-79.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Eikelboom JW, Quinlan DJ, Douketis JD. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet 2001; 358: 9-15.
    CrossrefPubMedGoogle Scholar