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An expert commentary by Dr Victor F. Tapson, MD
Reduced mobility is a risk factor for the development of venous thromboembolism (VTE). Therefore, all patients should be considered for VTE prophylaxis upon hospital admission. In this Expert Commentary, Dr Victor F. Tapson describes the types of medical patients studied in VTE clinical trials and the variety of pharmacological and nonpharmacological options available for prophylaxis of VTE. He discusses the risks and benefits associated with each option, including heparin, low-molecular-weight heparin, warfarin, fondaparinux, ximelagatran, and mechanical methods of prophylaxis.
There are little data to guide physicians on the optimal duration of prophylaxis. According to Dr Tapson, many experts consider the patient’s mobility in deciding on postdischarge prophylaxis. He also discusses the frequency of postdischarge surveillance and monitoring.
Dr Tapson is a Professor of Medicine in the Division of Pulmonary and Critical Care Medicine and the Director of the Pulmonary Vascular Disease Center at Duke University Medical Center.
References
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2. Alikhan R, Cohen AT, Combe S, et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis. 2003;14:341-346.
3. Brophy DF, Dougherty JA, Garrelts JC, et al. Venous thromboembolism prevention in acutely ill nonsurgical patients. Ann Pharmacother. 2005;39:1318-1324.
4. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:338S-400S.
5. Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005;352:969-977.
6. Leizorovicz A, Cohen AT, Turpie AGG, Olsson C-G, Vaitkus PT, Goldhaber SZ, for the PREVENT Medical Thromboprophylaxis Study Group. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110:874-879.
7. Spyropoulos AC. Emerging strategies in the prevention of venous thromboembolism in hospitalized medical patients. Chest. 2005;128:958-969.
8. Tapson VF, Hyers TM, Waldo AL, et al, for the NABOR (National Anticoagulation Benchmark and Outcomes Report) Steering Committee. Antithrombotic therapy practices in US hospitals in an era of practice guidelines. Arch Intern Med. 2005;165:1458-1464.
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