Extended Duration of Thromboprophylaxis for Medically Ill Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Intern Med J. 2019 Jul 05;:
Authors: Zayed Y, Kheiri B, Barbarawi M, Banifadel M, Abdalla A, Chahine A, Obeid M, Haykal T, Yelangi A, Malapati S, Bachuwa G, Seedahmed E
BACKGROUND: The benefit of extended duration thromboprophylaxis in patients hospitalized for acute medical illness beyond hospital stay remains controversial.
AIM: To perform a meta-analysis of randomized controlled trial (RCTs) in order to examine the efficacy and safety of extended-duration anticoagulation for venous-thromboembolism (VTE) prophylaxis in this high-risk population.
METHODS: An electronic database search was conducted to include all RCTs comparing between extended-duration versus short-duration prophylactic anticoagulation in medically ill patients. The primary efficacy outcome was the composite events of asymptomatic deep vein thrombosis (DVT), symptomatic VTE, and death from VTE-related causes.
RESULTS: Five RCTs were included totaling 40,124 patients with a mean age of 71 years and 51% were male. In comparison to standard-duration therapy, extended-duration thromboprophylaxis was associated with a significant reduction in the primary efficacy outcome (RR 0.75; 95% CI 0.67-0.85; P<0.01), symptomatic VTE (RR 0.53; 95 % CI 0.33-0.84; P<0.01), and asymptomatic DVT (RR 0.81; 95% CI 0.71-0.94; P<0.01). However, there were no significant differences between both groups with regard to VTE-related death (RR 0.81; 95% CI 0.60-1.10; P=0.18) or all-cause death (RR 0.97; 95% CI 0.88-1.08; P=0.64). In contrast, extended-duration thromboprophylaxis was associated with an increased risk of major bleeding (RR 2.04; 95% CI 1.42-2.91; P<0.01) and non-major clinically relevant bleeding (RR 1.81; 95% CI 1.29-2.53; P<0.01).
CONCLUSIONS: Among hospitalized medically ill patients, prolonging venous thromboprophylaxis was associated with a decreased risk of composite events of the primary efficacy outcome and increased risk of bleeding with no significant difference in VTE-related death. This article is protected by copyright. All rights reserved.
PMID: 31276276 [PubMed - as supplied by publisher]