Primary antithrombotic prevention of venous thrombosis in internal medicine

Česká verzia

Authors: J. Kvasnička
Authors place of work: Trombotické centrum VFN, Praha, přednosta prof. MUDr. Jan Kvasnička, DrSc.
Published in the journal: Vnitř Lék 2005; 91(7 a 8): 781-789
Category: 128th Internal Medicine Day - 21rd Vanysek's Day Brno 2005

Summary

Two large clinical studies MEDENOX and PREVENT in acute ill medical patients show a consistent 50% reduction in venous thromboembolism (VTE) with low molecular heparin (LMWH) prophylaxis. Therefore, the prophylaxis of VTE with low dose of unfractioned heparin (grade 1 A) or LMWH (grade 1 A) is now recommended to the medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed (for more than 72 hours) and have one or more additional risk factors (infection, prior VTE, cancer, thrombophilia etc). But this recommendation is not widely practiced, partly due to the heterogenity of this group. Current prophylaxis for VTE in high-risk situations, such as sepsis, can be also suboptimal. Our results show that 54.7% of septic patients hospitalized in an intensive care unit and using prophylactic doses of LMWH had an inhibition of F Xa under 0.2 IU/mL, therefore they were underanticoagulated too. The article discusses the importance of laboratory monitoring of LMWH in acute ill patients with presumptive continuous progression of thrombin generation, e.g. in sepsis.

Key words:
heparin – LMWH – prophylaxis – venous thrombosis – internal medicine – laboratory monitoring

Zdroje

1. Puchmayer V, Roztočil K. Praktická angiologie. Praha: Triton 2000: 191.

2. Chochola M, Vařejka P, Staněk F et al. Novinky v diagnostice a léčbě hluboké žilní trombózy dolních končetin. Čas Lék Čes 2000; 139: 583.

3. Oger E et al. EPI-GETBO Study Group. Incidence of venous thromboembolism: A community-based study in western France. Thromb Haemost. 2000; 83: 657–660.

4. Heit JA, Silverstein MD, Mohr DN et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001; 86: 452–463.

5. Dalen J, Hirsh J, Guyatt GH et al. 6^th ACCP Consensus Conference on Antithrombotic Treatment. Chest 2001; 119 (Suppl): 1S–S344.

6. Geerts WH, Pineo GF, Heit JA et al. Prevention of venous thromboembolism. The 7^th ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126: 338S–400S.

7. Hirsh J, Raschke R. Heparin and low-molecular-weight heparin. The 7^th ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126: 188S–203S.

8. Gallus AS, Hirsh J. Prevention of venous thrombosis. Sem Thromb Haemost 1976; 2: 232–239.

9. Kvasnička J, Pešková M. Současný stav prevence trombembolických komplikací v chirurgii. Čas Lék Čes 1992; 131: 165–169.

10. Venous thromboembolism cause 25 000 deaths a year, say MPs. Editorial. Br Med J 2005; 330: 559.

11. Oger E, Bressollette L, Nonent M et al. High prevalence of asymptomatic deep vein thrombosis on admission in a medical unit among eldery patients (the Tadeus project). Thromb Haemost 2002; 88: 592–597.

12. Auzký O, Piťha J. Výskyt a příčiny hluboké žilní trombózy dolních končetin v neselektované populaci interních pacientů. Cor Vasa 2005; 47: 45–49.

13. Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet 1999; 353: 1167–1173.

14. Lapostolle F, Burget V, Borron SW et al. Severe pulmonary embolism associated with air travel. N Engl J Med 2001; 345: 779–783.

15. Smith PD. Neutrophil activation and mediators of inflammation in chronic venous insufficiency. J Vasc Res 1999; 36(Suppl 1): 24–36.

16. European Concensus statement (Winsdor 1991, UK): Prevention of venous thromboembolism. London: Med-Orion Publishing 1993: 20.

17. Becker BF, Heindl B, Kupatt C et al. Endothelial function and hemostasis. Z Kardiol 2000; 89: 160–167.

18. Carlos TM, Harlan JM. Review: Leukocyte-endothelial adhesion molecules. Blood 1994; 84: 2068–2101.

19. Gabay C, Kushner I. Acute-phase proteins and other systemic response to inflammation. N Engl J Med 1999; 340: 448–454.

20. van Aken BE, den Heijer M, Bos GMJ et al. Recurrent venous thrombosis and markers of inflammation. Thromb Haemost 2000; 83: 536–539.

21. Alikhan R, Cohen AT, Combe S et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness. Analysis of the MEDENOX Study. Arch Intern Med 2004; 164: 963–968.

22. Hymes KB, Karpatkin S. Thrombosis in cancer patients. In: Verstraete M, Fuster V, Topol EJ (eds). Cardiovascular thrombosis. Philadelphia: Lippincot-Raven 1998: 733–744.

23. Agnelli G. Venous thromboembolism and cancer: a two-way clinical association. Thromb Haemost 1997; 78: 117–120.

24. Svendsen E, Karwinski B. Prevalence of pulmonary embolism at necropsy in patients with cancer. J Clin Pathol 1989; 42: 805–809.

25. Thodiyil PA, Kakar AK. Variation in relative risk of venous thromboembolism in different cancers. Thromb Haemost 2002; 87: 1076–1077.

26. Gori AM, Fedi S, Pepe G et al. Tissue factor and tissue factor pathway inibitor levels in unstable angina pectoris patients during short-term low-molecular-weight heparin administration. Br J Haematol 2002; 117: 693–698.

27. Leadley RJ jr, Chi L, Porcari AR. Nonhemostatic activity of coagulation factor Xa: potential implications for various diseases. Curr Opinion in Pharmacology 2001; 1: 169–175.

28. Bono F, Schaeffer P, Hérault JP et al. Factor Xa acivates endothelial cells by a receptor cascade between EPR-1 and PAR-2. Arterioscler Thromb Vasc Biol 2000; 20: e107–e112.

29. Cirino G, Cicala C, Bucci M et al. Factor Xa as an interface between coagulation and inflammation. J Clin Invest 1997; 99: 2446–2451.

30. Leizorovicz A, Cohen AT, Turpie AGG et al. Randomized, placebo-controled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patiens. Circulation 2004; 110: 874–879.

31. 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. Prophylaxis in Medical Patient with Enoxaparin Study Group. N Engl J Med 1999; 341: 793–800.

32. Kakar AK, Levine MN, Kadziola Z et al. Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the Fragmin Advanced Malignancy Outcome Study (FAMOUS). J Clin Oncology

2004; 22: 1944–1948.

33. Lee AYY, Levin MN, Baker RI et al. Lowmolecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patiens with cancer. N Engl J Med 2003; 349: 146–153.

34. Douketis JD, Kearon C, Bates S et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA 1998; 279: 458–462.

35. Hirsh DR, Ingenito EP, Goldhaber SZ. Prevalence of deep venous thrombosis among patients in medical intensive care. JAMA 1995; 274: 335–337.

36. Geerts W, Selby R. Prevention of venous thromboembolism in the ICU. Chest 2003; 124: 357S–363S.

37. Attia J, Ray JG, Cook DJ et al. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med 2001; 161: 1268–1279.

38. Timsit J-F, Farkas JCh, Boy JM et al. Central vein catheter–related thrombosis in intensive care patient. Incidence, risk factors, and relationships with catheter-related sepsis. Chest 1998; 114: 207–213.

39. Weill-Engerer S, Meaume S, Lahlou A et al. Risk factors for deep vein thrombosis in patients aged 65 and older: a casecontrol multicenter study. J Amer Geriatr Soc 2004; 52: 1299–1304.

40. Mayr AJ, Dünser M, Jochberger S et al. Anti factor Xa activity in intensive care patients receiving thromboembolic prophylaxis with standard doses of enoxaparin. Thromb Research 2002; 105: 201–204.

41. Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250–1256.

42. Riedeman NC, Guo R-F, Ward PA. The enigma of sepsis. J Clin Invest 2003; 112: 460–467.