Evidens för trombosprofylax till medicinpatienter med hög risk

Venous thromboembolism (VTE) is a common complication of hospitalization, and can result in substantial morbidity and treatment cost. In orthopedic and general surgery, it is common practice to use low-molecular-weight heparin as a thromboprophylaxis. For medical patients, however, the issue of prophylaxis remains under debate. Data from three recent large randomized studies of medical patients at risk for VTE: PREVENT, MEDENOX and ARTEMIS, were combined. They showed an absolute risk reduction (ARR) for symptomatic VTE of 0,48 percent, asymptomatic VTE of 2,5 percent with a subsequent increase in major bleedings of 0,38 percent. In most studies, low-molecular-weight heparin reduces the risk of VTE by approximately 45 percent. Thus, the prophylaxis may be efficient, but its clinical use is limited to patient populations with a high incidence of VTE. Further studies to identify medical patients who are at high risk and would benefit from prophylaxis are warranted.