Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients: where is the evidence?

Matthew F. G. Greig, Stuart B Rochow, Michael A. Crilly, Arduino A. Mangoni

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

It has been claimed that there are over 25,000 preventable in-hospital deaths from venous thromboembolism annually in the UK. NICE and SIGN guidelines therefore recommend that all hospitalised patients are risk assessed for venous thromboembolism. The guidelineswould recommend using pharmacological thromboprophylaxis for all patients aged 60 and above with reduced mobility and acute medical illness unless obvious contra-indications exist. Meta-analysis data regarding pharmacological thromboprophylaxis for medical patients demonstrate reductions in asymptomatic deep vein thrombosis (DVT) rather than fatal pulmonary embolism and mortality. There is also the potential for increased bleeding risk with this approach. Evidence for older medical in-patients, particularly those aged over 75, is more limited being derived from subgroup analyses of larger clinical trials. In addition, based on exclusion criteria such as increased bleeding risk, frailer older adults were unlikely to have been included within such trials. This commentary will (i) critically appraise available data on the incidence of DVT and PE in older hospitalised patients; (ii) review the evidence available from metaanalyses and subgroup analyses in older medical in-patients for the use of venous thromboembolism prophylaxis; (iii) discuss those situations out-with the guidelines where venous thromboprophylaxis may not be appropriate and even potentially harmful in this patient group and (iv) suggest future research directions.
Original languageEnglish
Pages (from-to)428-434
Number of pages7
JournalAge and Ageing
Volume42
Issue number4
Early online date4 Apr 2013
DOIs
Publication statusPublished - 1 Jul 2013

Fingerprint

Venous Thromboembolism
Pharmacology
Venous Thrombosis
Guidelines
Hemorrhage
Frail Elderly
Pulmonary Embolism
Meta-Analysis
Clinical Trials
Mortality
Incidence

Keywords

  • venous thromboembolism
  • deep vein thrombosis
  • pulmonary embolism
  • prophylaxis
  • older people
  • elderly

Cite this

Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients : where is the evidence? / Greig, Matthew F. G.; Rochow, Stuart B; Crilly, Michael A. ; Mangoni, Arduino A. .

In: Age and Ageing, Vol. 42, No. 4, 01.07.2013, p. 428-434.

Research output: Contribution to journalArticle

Greig, Matthew F. G. ; Rochow, Stuart B ; Crilly, Michael A. ; Mangoni, Arduino A. . / Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients : where is the evidence?. In: Age and Ageing. 2013 ; Vol. 42, No. 4. pp. 428-434.
@article{4a466ee1b9de456593f4eb341f54c16f,
title = "Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients: where is the evidence?",
abstract = "It has been claimed that there are over 25,000 preventable in-hospital deaths from venous thromboembolism annually in the UK. NICE and SIGN guidelines therefore recommend that all hospitalised patients are risk assessed for venous thromboembolism. The guidelineswould recommend using pharmacological thromboprophylaxis for all patients aged 60 and above with reduced mobility and acute medical illness unless obvious contra-indications exist. Meta-analysis data regarding pharmacological thromboprophylaxis for medical patients demonstrate reductions in asymptomatic deep vein thrombosis (DVT) rather than fatal pulmonary embolism and mortality. There is also the potential for increased bleeding risk with this approach. Evidence for older medical in-patients, particularly those aged over 75, is more limited being derived from subgroup analyses of larger clinical trials. In addition, based on exclusion criteria such as increased bleeding risk, frailer older adults were unlikely to have been included within such trials. This commentary will (i) critically appraise available data on the incidence of DVT and PE in older hospitalised patients; (ii) review the evidence available from metaanalyses and subgroup analyses in older medical in-patients for the use of venous thromboembolism prophylaxis; (iii) discuss those situations out-with the guidelines where venous thromboprophylaxis may not be appropriate and even potentially harmful in this patient group and (iv) suggest future research directions.",
keywords = "venous thromboembolism , deep vein thrombosis, pulmonary embolism, prophylaxis, older people, elderly",
author = "Greig, {Matthew F. G.} and Rochow, {Stuart B} and Crilly, {Michael A.} and Mangoni, {Arduino A.}",
year = "2013",
month = "7",
day = "1",
doi = "10.1093/ageing/aft041",
language = "English",
volume = "42",
pages = "428--434",
journal = "Age and Ageing",
issn = "0002-0729",
publisher = "OXFORD UNIV PRESS INC",
number = "4",

}

TY - JOUR

T1 - Routine pharmacological venous thromboembolism prophylaxis in frail older hospitalised patients

T2 - where is the evidence?

AU - Greig, Matthew F. G.

AU - Rochow, Stuart B

AU - Crilly, Michael A.

AU - Mangoni, Arduino A.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - It has been claimed that there are over 25,000 preventable in-hospital deaths from venous thromboembolism annually in the UK. NICE and SIGN guidelines therefore recommend that all hospitalised patients are risk assessed for venous thromboembolism. The guidelineswould recommend using pharmacological thromboprophylaxis for all patients aged 60 and above with reduced mobility and acute medical illness unless obvious contra-indications exist. Meta-analysis data regarding pharmacological thromboprophylaxis for medical patients demonstrate reductions in asymptomatic deep vein thrombosis (DVT) rather than fatal pulmonary embolism and mortality. There is also the potential for increased bleeding risk with this approach. Evidence for older medical in-patients, particularly those aged over 75, is more limited being derived from subgroup analyses of larger clinical trials. In addition, based on exclusion criteria such as increased bleeding risk, frailer older adults were unlikely to have been included within such trials. This commentary will (i) critically appraise available data on the incidence of DVT and PE in older hospitalised patients; (ii) review the evidence available from metaanalyses and subgroup analyses in older medical in-patients for the use of venous thromboembolism prophylaxis; (iii) discuss those situations out-with the guidelines where venous thromboprophylaxis may not be appropriate and even potentially harmful in this patient group and (iv) suggest future research directions.

AB - It has been claimed that there are over 25,000 preventable in-hospital deaths from venous thromboembolism annually in the UK. NICE and SIGN guidelines therefore recommend that all hospitalised patients are risk assessed for venous thromboembolism. The guidelineswould recommend using pharmacological thromboprophylaxis for all patients aged 60 and above with reduced mobility and acute medical illness unless obvious contra-indications exist. Meta-analysis data regarding pharmacological thromboprophylaxis for medical patients demonstrate reductions in asymptomatic deep vein thrombosis (DVT) rather than fatal pulmonary embolism and mortality. There is also the potential for increased bleeding risk with this approach. Evidence for older medical in-patients, particularly those aged over 75, is more limited being derived from subgroup analyses of larger clinical trials. In addition, based on exclusion criteria such as increased bleeding risk, frailer older adults were unlikely to have been included within such trials. This commentary will (i) critically appraise available data on the incidence of DVT and PE in older hospitalised patients; (ii) review the evidence available from metaanalyses and subgroup analyses in older medical in-patients for the use of venous thromboembolism prophylaxis; (iii) discuss those situations out-with the guidelines where venous thromboprophylaxis may not be appropriate and even potentially harmful in this patient group and (iv) suggest future research directions.

KW - venous thromboembolism

KW - deep vein thrombosis

KW - pulmonary embolism

KW - prophylaxis

KW - older people

KW - elderly

UR - http://www.scopus.com/inward/record.url?scp=84879857709&partnerID=8YFLogxK

U2 - 10.1093/ageing/aft041

DO - 10.1093/ageing/aft041

M3 - Article

AN - SCOPUS:84879857709

VL - 42

SP - 428

EP - 434

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 4

ER -