[Pharmacological Thromboprophylaxis in Acutely Ill Hospitalized Medical Patients]

Abstract

Venous thromboembolic events (VTE) occur in approximately 50% of cases during or following hospitalization; VTE are a major cause of morbidity and mortality. Thromboprophylaxis for 6 to 14 days with heparins or fondaparinux has been demonstrated to be effective in VTE prevention in patients hospitalized for acute medical illnesses and reduced mobility. Nevertheless, the level of recommendation has been gradually downgraded as the benefit has been mainly demonstrated on the basis of systematic imaging diagnosed events. Direct oral anticoagulants have been assessed only as an extended prophylaxis, and are currently not recommended in medical thromboprophylaxis. Assessing the risk of VTE and bleeding in medical patients is complex. VTE and bleeding risk assessment scores were constructed but have not been validated. In order to improve the adequacy of prescriptions for thromboprophylaxis, the impact of different interventions has been the subject of several studies but these yielded varying results. The aim of this review is to analyze the indications for thromboprophylaxis in a medical setting with the latest available data.

Keywords: Acute medical disease; Anticoagulants oraux directs; Direct oral anticoagulants; Héparines de bas poids moléculaires; Low molecular weight heparins; Maladie veineuse thromboembolique; Pathologie médicale aiguë; Thromboembolic venous disease; Thromboprophylaxie; Thromboprophylaxis.