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VTE in Infectious Diseases

Infectious diseases carry a risk of VTE development. These patients have approximately 3-fold increased risk of VTE (odds ratio for triggering VTE between 2.0 and 3.9).1,2

Patients with severe infection represent a large proportion of subjects hospitalized for acute medical illness. In the large-scale MEDENOX study looking at VTE prevention in acutely ill patients, 53% of the cohort had an infectious disease, and it was calculated in multivariate analysis that acute infectious disease conferred an odds ratio for VTE of 1.74.2,3 The rate of VTE in patients in this study who received placebo was 15.5%.3,4 Active thromboprophylaxis with the LMWH enoxaparin reduced the rate of VTE to 6.3%, representing a relative risk of 0.41 (relative risk reduction of 59%).4

The ARTEMIS study, comparing fondaparinux prophylaxis with placebo, also noted that there was an incidence of 11.4% VTE in placebo patients, which was reduced to 5.2% by thromboprophylaxis.5

The heterogenous nature of infectious disease patients, and a lack of awareness or appreciation of their true risk of VTE, has hampered attempts at VTE prevention.6

Among the possible barriers to providing appropriate VTE prophylaxis to this group of patients are fears that antithrombotic therapy may have bleeding risk. In patients with conditions such as HIV/AIDS, there may be worries that oral anticoagulant therapy could have an adverse pharmacokinetic interaction with antiretroviral therapy.

References

  1. 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.
  2. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med. 2000;160:3415-20.
  3. Alikhan R, Cohen AT, et al. Risk factors for venous thromboembolism in hospitalized
    patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med. 2004;164:963-8.
  4. 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.
  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. Smeeth L, Cook C, et al. Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting. Lancet. 2006;367:1075-9.
 
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