Abstract:
:Low molecular weight heparins and fondaparinux have been the cornerstones for prevention of venous thromboembolism (VTE) in acutely ill medical patients for almost two decades. Guidelines recommend the use of these parenteral anticoagulants for 6 to 14 days but advise against extended-duration thromboprophylaxis after hospital discharge because no compelling scientific evidence has been provided for pharmacological prophylaxis beyond hospital stay. Five large randomized clinical trials, one with low molecular weight heparin and four with nonvitamin K antagonist oral anticoagulants, have failed to show significant clinically relevant benefit in this indication. Obviously, the development of VTE is more complex in medical patients than in patients undergoing major surgical procedures. Thus, it can be expected that guideline recommendations for VTE prevention with low molecular weight heparins or fondaparinux in medical patients will remain unchanged in 2019. :Über zwei Jahrzehnte waren niedermolekulare Heparine und Fondaparinux die Eckpfeiler der venösen Thromboembolie-Prophylaxe für Patienten mit akuten internistischen Erkrankungen. In den Leitlinien wird diese Art der Prophylaxe für 6 bis 14 Tage empfohlen, jedoch wird von einer verlängerten Dauer der Prophylaxe über den Krankenhausaufenthalt hinaus wegen fehlender wissenschaftlicher Evidenz abgeraten. In fünf großen randomisierten Studien, davon eine mit niedermolekularem Heparin und vier mit Nicht-Vitamin K antagonistischen oralen Antikoagulanzien, konnte für diese Indikation kein signifikanter, klinisch relevanter Vorteil nachgewiesen werden. Vermutlich ist die Entstehung venöser Thromboembolien bei internistischen Patienten komplexer als bei Patienten mit chirurgischen Eingriffen. Deshalb ist zu erwarten, dass die Leitlinienempfehlungen zur venösen Thromboembolie-Prophylaxe mit niedermolekularen Heparinen oder Fondaparinux für internistische Patienten auch im Jahr 2019 unverändert bleiben.
journal_name
Hamostaseologiejournal_title
Hamostaseologieauthors
Haas Sdoi
10.1055/s-0038-1677522subject
Has Abstractpub_date
2019-02-01 00:00:00pages
62-66issue
1eissn
0720-9355issn
2567-5761journal_volume
39pub_type
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