Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients

Brandon Cave, Augustus Hough, Paul P. Dobesh

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with most events occurring within 30 days of hospital discharge. Therefore, the 30-day time period postdischarge has been identified as a stage in which patients are still at high risk of developing VTE. Attempts to provide extended prophylaxis with enoxaparin, rivaroxaban, or apixaban in patients with acute medical illness have been met with mixed results. Although some of these agents have reduced the incidence of VTE with extended prophylaxis, all of these agents have also demonstrated a significant increase in major bleeding that seems to offset any potential benefit. A recent trial of a new direct factor Xa inhibitor, betrixaban, demonstrated a reduction in VTE events with extended prophylaxis without significantly increasing the risk of major bleeding. Understanding appropriate patient selection, dosing, and outcomes associated with betrixaban will be important to potentially reducing the continued risk of VTE in patients with acute medical illness.

Original languageEnglish (US)
Pages (from-to)597-609
Number of pages13
JournalPharmacotherapy
Volume38
Issue number6
DOIs
StatePublished - Jun 2018

Fingerprint

Venous Thromboembolism
Hospitalization
Hemorrhage
Enoxaparin
Patient Selection
Inpatients
Clinical Trials
Incidence

Keywords

  • apixaban
  • betrixaban
  • enoxaparin
  • prophylaxis
  • rivaroxaban
  • venous thromboembolism

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients. / Cave, Brandon; Hough, Augustus; Dobesh, Paul P.

In: Pharmacotherapy, Vol. 38, No. 6, 06.2018, p. 597-609.

Research output: Contribution to journalReview article

Cave, Brandon ; Hough, Augustus ; Dobesh, Paul P. / Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients. In: Pharmacotherapy. 2018 ; Vol. 38, No. 6. pp. 597-609.
@article{82e23d504eef4c67a1c95b6d0773e816,
title = "Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients",
abstract = "Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with most events occurring within 30 days of hospital discharge. Therefore, the 30-day time period postdischarge has been identified as a stage in which patients are still at high risk of developing VTE. Attempts to provide extended prophylaxis with enoxaparin, rivaroxaban, or apixaban in patients with acute medical illness have been met with mixed results. Although some of these agents have reduced the incidence of VTE with extended prophylaxis, all of these agents have also demonstrated a significant increase in major bleeding that seems to offset any potential benefit. A recent trial of a new direct factor Xa inhibitor, betrixaban, demonstrated a reduction in VTE events with extended prophylaxis without significantly increasing the risk of major bleeding. Understanding appropriate patient selection, dosing, and outcomes associated with betrixaban will be important to potentially reducing the continued risk of VTE in patients with acute medical illness.",
keywords = "apixaban, betrixaban, enoxaparin, prophylaxis, rivaroxaban, venous thromboembolism",
author = "Brandon Cave and Augustus Hough and Dobesh, {Paul P.}",
year = "2018",
month = "6",
doi = "10.1002/phar.2102",
language = "English (US)",
volume = "38",
pages = "597--609",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",
number = "6",

}

TY - JOUR

T1 - Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients

AU - Cave, Brandon

AU - Hough, Augustus

AU - Dobesh, Paul P.

PY - 2018/6

Y1 - 2018/6

N2 - Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with most events occurring within 30 days of hospital discharge. Therefore, the 30-day time period postdischarge has been identified as a stage in which patients are still at high risk of developing VTE. Attempts to provide extended prophylaxis with enoxaparin, rivaroxaban, or apixaban in patients with acute medical illness have been met with mixed results. Although some of these agents have reduced the incidence of VTE with extended prophylaxis, all of these agents have also demonstrated a significant increase in major bleeding that seems to offset any potential benefit. A recent trial of a new direct factor Xa inhibitor, betrixaban, demonstrated a reduction in VTE events with extended prophylaxis without significantly increasing the risk of major bleeding. Understanding appropriate patient selection, dosing, and outcomes associated with betrixaban will be important to potentially reducing the continued risk of VTE in patients with acute medical illness.

AB - Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with most events occurring within 30 days of hospital discharge. Therefore, the 30-day time period postdischarge has been identified as a stage in which patients are still at high risk of developing VTE. Attempts to provide extended prophylaxis with enoxaparin, rivaroxaban, or apixaban in patients with acute medical illness have been met with mixed results. Although some of these agents have reduced the incidence of VTE with extended prophylaxis, all of these agents have also demonstrated a significant increase in major bleeding that seems to offset any potential benefit. A recent trial of a new direct factor Xa inhibitor, betrixaban, demonstrated a reduction in VTE events with extended prophylaxis without significantly increasing the risk of major bleeding. Understanding appropriate patient selection, dosing, and outcomes associated with betrixaban will be important to potentially reducing the continued risk of VTE in patients with acute medical illness.

KW - apixaban

KW - betrixaban

KW - enoxaparin

KW - prophylaxis

KW - rivaroxaban

KW - venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=85046039274&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046039274&partnerID=8YFLogxK

U2 - 10.1002/phar.2102

DO - 10.1002/phar.2102

M3 - Review article

C2 - 29543384

AN - SCOPUS:85046039274

VL - 38

SP - 597

EP - 609

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 6

ER -