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VTE in Respiratory Diseases

Patients with respiratory disease form a substantial group of hospitalized patients with an appreciable risk of VTE. Chronic obstructive pulmonary disease (COPD) patients have an approximately 3-fold increase in risk of VTE (odds ratio of 2.9).1

In the MEDENOX study, which assessed LMWH prophylaxis in acutely ill patients, 53.4% of the cohort had respiratory disease.2 Subgroup analysis of MEDENOX data, assessing the effects of enoxaparin versus placebo in patients with respiratory disease, found that prophylactic LMWH resulted in a relative risk for VTE of 0.25 in subjects with acute respiratory failure (95% CI, 0.10–0.65) (relative risk reduction of 75%) and a relative risk reduction for VTE of 0.26 in the pre-defined risk-factor subgroup with chronic respiratory failure (95% CI, 0.10–0.68) (relative risk reduction of 74%).3

The beneficial effects of thromboprophylaxis in patients with respiratory disease have also been noted in the PREVENT study, comparing the LMWH dalteparin with placebo, where active therapy provided a 28% relative risk reduction VTE in subjects with respiratory failure.4 Likewise, the ARTEMIS study, comparing fondaparinux with placebo, noted that in patients with respiratory illness, thromboprophylactic therapy reduced the rate of VTE from 5.5% to 1.6%.5

In the THE-PRINCE study, which compared UFH and LMWH (enoxaparin) for VTE prevention in a patient population that included subjects with severe respiratory disease, prophylaxis was again effective in reducing VTE risk, and treatment efficacy was comparable.6

Current guidelines on use of thromboprophylaxis give clear recommendations regarding patients with severe respiratory disease. The 7th ACCP guidelines give a Grade 1A, and the International Consensus Statement a Grade A, recommendation that these patients should receive LMWH or low-dose unfractionated heparin (LDUH).7,8

References

  1. Samama MM, Dahl OE, et al. Quantification of risk factors for venous thromboembolism: a preliminary study for the development of a risk assessment tool. Haematologica. 2003;88:1410-21.
  2. Samama MM, Cohen AT, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med. 1999;341:793-800.
  3. Alikhan R, Cohen AT, et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis. 2003;14:341-6.
  4. Leizorovicz A, Cohen AT, et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110:874-9.
  5. Cohen AT, Davidson BL, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ. 2006;332:325-9.
  6. Kleber FX, Witt C, et al. Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J. 2003;145:614-21.
  7. Geerts WH, Pineo GF, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126 Suppl 3: 338S-400S.
  8. Nicolaides AN, Breddin HK, et al. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol. 2001;20:1-37.
 
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