Abstract:
BACKGROUND:The role of extended thromboprophylaxis is established for surgical patients, but not yet for hospitalised medical patients. DESIGN:This systematic review and meta-analysis sought to explore the role of extended thromboprophylaxis for medically ill hospitalised patients. METHODS:Medline, EMBASE and Cochrane Libraries were searched and five randomised controlled trials were identified, comprising 20,046 extended and 20,078 standard duration thromboprophylaxis patients. RESULTS:Allocation to extended treatment, compared with standard duration therapy, significantly reduced the risk of symptomatic deep vein thrombosis (relative risk (RR) 0.47, 95% confidence interval (CI) 0.29-0.78, P = 0.003) and non-fatal pulmonary embolism (RR 0.59, 95% CI 0.39-0.91, P = 0.02). The risk of venous thromboembolism-related death was comparable between the extended and standard duration treatment groups (RR 0.81, 95% CI 0.6-1.09, P = 0.16). Extended treatment also doubled the risk of major bleeding (RR 2.04, 95% CI 1.42-2.91, P < 0.001), without significantly affecting the risk of intracranial bleeding or bleeding-associated death. The cost of preventing one symptomatic deep vein thrombosis and non-fatal pulmonary embolism was found to be £24,972 (€27,969) and £45,148 (€50,566), respectively, which outweigh the direct cost of managing established venous thromboembolism as previously reported. CONCLUSIONS:Extended duration thromboprophylaxis caused a reduction in the risk of venous thromboembolic events, but also a numerically comparable increase in major bleeding. Further trials are required in high-risk subpopulations who may derive mortality benefits from treatment. Only then could a change in current policy and practice be supported.
journal_name
Eur J Prev Cardioljournal_title
European journal of preventive cardiologyauthors
Cao JY,Lee SY,Dunkley S,Adams M,Keech Adoi
10.1177/2047487319836572subject
Has Abstractpub_date
2019-03-16 00:00:00pages
2047487319836572eissn
2047-4873issn
2047-4881pub_type
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