Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux

Figures & data

Table 1 Acute medical illnesses and predisposing risk factors for venous thromboembolism in hospitalized medical patients

Acute medical illnesses

Acute congestive heart failure (NYHA Class III or IV)

Acute respiratory disease

Acute infectious disease

Acute rheumatic disease

Inflammatory bowel disease

Ischemic stroke

Acute myocardial infarction

Predisposing factors

Previous venous thromboembolism

Older age (especially >70 years)

Marked reduction of mobility

Malignancy

Recent (≤1 month) trauma and/or surgery

Obesity (BMI > 30)

Inherited or acquired thrombophilic states (eg, antiphospholipid syndrome)

Varicose veins

Estrogen therapy or pregnancy

Chronic kidney disease

Invasive procedures (eg, central venous catheterization)

Abbreviations: BMI, body mass index; NYHA, New York Heart Association.

Table 2 Drugs for prophylaxis of venous thromboembolism in hospitalized medical patients

Drug	Dose	Comment
Unfractionated heparin	5,000 ∪ subcutaneously, twice or three times daily*	In critically ill patients, only doses of 5,000 U twice daily have been studied
Low molecular weight heparins
Enoxaparin (Lovenox®)	40 mg subcutaneously, once daily
Dalteparin (Fragmin®)	5,000 ∪ subcutaneously, once daily
Tinzaparin (Innohep®)	4,500 ∪ subcutaneously, once daily
Nadroparin (Fraxiparin®)	2,850 ∪ subcutaneously, once daily
Parnaparin (Fluxum®)	4,250 ∪ subcutaneously, once daily
Fondaparinux (Arixtra®)	2.5 mg subcutaneously, once daily	In case of creatinine clearance between 20 and 50 mL per minute, lower dose of 1.5 mg subcutaneously once daily

Note:

* No head-to-head trials comparing twice daily versus three times daily, but indirect comparisons do not suggest that UFH three times daily dosing, compared with twice daily dosing, reduces VTE or causes more bleeding.

Abbreviations: UFH, unfractionated heparin; VTE, venous thromboembolism.