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  • Thromboprophylaxis in medical inpatients reduces pulmonary embolism, increases the risk of major haemorrhage and does not reduce total mortality, producing questionable net clinical benefit

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Therapeutics
Systematic review
Thromboprophylaxis in medical inpatients reduces pulmonary embolism, increases the risk of major haemorrhage and does not reduce total mortality, producing questionable net clinical benefit
  1. Mark Crowther1,
  2. David G Gracia2
  1. 1Department of Medicine, McMaster University & St Joseph's Hospital, Hamilton, Canada
  2. 2Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
  1. Correspondence to Mark Crowther
    Department of Medicine, McMaster University & St Joseph's Hospital, Rm L301, 50 Charlton Ave East, Hamilton, Ontario, L8N 4A6, Canada; crowthrm{at}mcmaster.ca

https://doi.org/10.1136/ebmed-2012-100509

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    Commentary on: Lederle FA, Zylla D, MacDonald R, et al. Venous thromboembolism prophylaxis in hospitalized medical patients and those with stroke: a background review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2011;155:602–15.OpenUrlCrossRefPubMedWeb of Science

    Context

    Effective pharmacological prophylaxis reduces venous thromboembolism (VTE) in high-risk medically-ill patients.1 But the net benefit of VTE prevention strategies in unselected medical patients is not established.

    Methods

    Lederle et al conducted a comprehensive meta-analysis of available clinical trials. Articles were identified by searching MEDLINE from 1950 through April 2011 and the Cochrane Library. A comprehensive search strategy was provided including details of searches for unpublished material, with good attention to study quality and a data extraction protocol. Studies providing separate data for medical patients or stroke patients in acute or intermediate care, healthcare facilities were included. The analysis included data from randomised trials that provided clinical outcomes and evaluated therapy with heparins or mechanical devices. Studies were included …

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    Footnotes

    • Competing interests MC has assisted in the development of educational material and/or sat on advisory boards for Bayer, Boehringer Ingelheim, Pfizer, Leo Pharma, CSL Behring and Octapharma. He is a Career Investigator of the Heart and Stroke Foundation of Ontario and holds the Leo Pharma Chair in Thromboembolism Research at McMaster University. DG has chaired or served on advisory boards for Boehringer Ingelheim, Bristol Meyers Squibb and Daiichi Sankyo and he has contributed to the development of educational materials used by Boehringer Ingelheim