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Extended-duration versus short-duration pharmacological thromboprophylaxis in acutely Ill hospitalized medical patients: a systematic review and meta-analysis of randomized controlled trials

Lookup NU author(s): Dr Aaron Liew

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Abstract

© 2016, Springer Science+Business Media New York. Extended-duration pharmacological thromboprophylaxis, for at least 28 days, is effective for the prevention of symptomatic venous thromboembolism (VTE) in high-risk surgical patients but is of uncertain benefit in hospitalized medical patients. We aimed to evaluate the efficacy and safety of extended-duration thromboprophylaxis in hospitalized medical patients. We conducted a systematic PubMed, Medline and EMBASE literature search until June 2016 and a meta-analysis of randomized controlled trials which compared extended-duration with short-duration thromboprophylaxis in hospitalized medical patients. Four randomized controlled trials comparing extended-duration prophylaxis (24–47 days) with short-duration prophylaxis (6–14 days) in a total of 34,068 acutely ill hospitalized medical patients were included. When compared with short-duration prophylaxis, extended-duration prophylaxis was associated with a decrease in symptomatic proximal or distal deep vein thrombosis (DVT) [relative risk (RR) = 0.52; 95% confidence interval (Cl): 0.35–0.77: p = 0.001; absolute risk reduction (ARR) = 0.32%, number needed to treat (NNT) = 313], and symptomatic non-fatal pulmonary embolism (RR = 0.61; 95% Cl 0.38–0.99: p = 0.04; ARR = 0.16%; NNT = 625), an increase in major bleeding (RR = 2.08; 95% Cl 1.50–2.90: p < 0.0001, absolute risk increase = 0.41%, number needed to harm = 244), and no significant reduction in VTE-related mortality (RR = 0.69; 95% Cl 0.45–1.06: p = 0.09) or all-cause mortality (RR = 1.00; 95% CI 0.89–1.12; p = 0.95). There was heterogeneity for major bleeding due to results from the APEX trial (no difference between betrixaban and enoxaparin). Compared with short-duration thromboprophylaxis, extended-duration treatment reduces the risk for symptomatic DVT and non-fatal pulmonary embolism. Extended treatment with apixaban, enoxaparin and rivaroxaban but not betrixaban increases the risk for major bleeding.

Publication metadata

Author(s): Liew AYL, Piran S, Eikelboom JW, Douketis JD

Publication type: Article

Publication status: Published

Journal: Journal of Thrombosis and Thrombolysis

Year: 2017

Volume: 43

Issue: 3

Pages: 291-301

Print publication date: 01/04/2017

Online publication date: 30/11/2016

Acceptance date: 02/04/2016

ISSN (print): 0929-5305

ISSN (electronic): 1573-742X

Publisher: Springer US

URL: https://doi.org/10.1007/s11239-016-1461-1

DOI: 10.1007/s11239-016-1461-1

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