Hospitalized Medical Patients Research Articles

The Prevalence of Sleep Disordered Breathing in Hospitalized Medical Patients

The Prevalence of Sleep Disordered Breathing in Hospitalized Medical Patients

Venous Thromboembolism (VTE) Prophylaxis in Hospitalized Medical Patients for Third-Year Medical Students

Abstract This team-based learning (TBL) module covers venous thromboembolism (VTE) prophylaxis. Students will effectively work together to select hospitalized medical patients who need VTE prophyla...

Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format

OPEN ACCESSJune 6, 2012Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format Jumana Antoun, MD, Nathalie Zgheib, MD, Zeina Kanafani, MD Jumana Antoun, MD American University of Beirut Google Scholar More articles by this author , Nathalie Zgheib, MD American University of Beirut Google Scholar More articles by this author , Zeina Kanafani, MD American University of Beirut Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9179 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis Team-based learning (TBL) module is one of seven bimonthly TBL modules used in the clinical pharmacology course that is offered to third-year medical students at the American University of Beirut Faculty of Medicine. The main objective of the course is to apply rational prescribing within several clinical case scenarios. Upon completion of this module, students will be able to effectively work together to manage patients with community acquired pneumonia, discuss the choice of appropriate empiric antimicrobials, and write a prescription for their choice.This case was recently introduced based on requests of students. It has so far been used twice, each time with six teams of third-year medical students. There is typically a very high level of interaction during the session. The medical students were highly satisfied with the course and the teaching approach, and their performance on prescription writing and formulary development has improved. Educational Objectives By the end of this session, learners will be able to: Work effectively in small groups to solve a clinical therapeutic case scenario.Determine whether a patient with community acquired pneumonia (CAP) should be treated as inpatient or outpatient.Choose an empiric antimicrobial therapy for the initial outpatient treatment of CAP.Develop a monitoring plan for the efficacy and toxicity of the chosen antimicrobial therapy.Write a prescription. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Application exercise clinical case document.doc CAP Instructor's Guide.doc RAT document.doc Student pre session document.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Treatment of Community Acquired Pneumonia for Third-Year Medical Students - Team-Based Learning (TBL) Format Venous Thromboembolism (VTE) Prophylaxis in Hospitalized Medical Patients for Third-Year Medical Students Treatment of Chronic Obstructive Pulmonary Disease (COPD) for Third-Year Medical Students Management of Nociceptive Pain for Third-Year Medical Students-Team Based Learning (TBL) Format Treatment of Type 2 Diabetes for Third-Year Medical Students Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: Team-Based Learning Copyright & Permissions© 2012 Antoun et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsAntimicrobialsTeam-based LearningPneumoniaTBL Disclosures None to report. Funding/Support None to report. Loading ...

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

Letters20 March 2012Venous Thromboembolism Prophylaxis in Hospitalized Medical PatientsAmir Qaseem, MD, PhD, MHA, Roger Chou, MD, Linda Humphrey, MD, MPH, and Paul Shekelle, MD, PhDAmir Qaseem, MD, PhD, MHAFrom American College of Physicians, Philadelphia, PA 19106; Oregon Health and Science University, Portland, OR 97201; and West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073.Search for more papers by this author, Roger Chou, MDFrom American College of Physicians, Philadelphia, PA 19106; Oregon Health and Science University, Portland, OR 97201; and West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073.Search for more papers by this author, Linda Humphrey, MD, MPHFrom American College of Physicians, Philadelphia, PA 19106; Oregon Health and Science University, Portland, OR 97201; and West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073.Search for more papers by this author, and Paul Shekelle, MD, PhDFrom American College of Physicians, Philadelphia, PA 19106; Oregon Health and Science University, Portland, OR 97201; and West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-6-201203200-00020 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Mills, Drs. Agutter and Malone, and Dr. Cundiff for their comments regarding the recent clinical guideline on VTE prophylaxis in hospitalized patients.In response to Dr. Mills, the pooled results from medical patients showed that prophylaxis with heparin is associated with a statistically significant reduction in PEs (absolute decrease, 4 events per 1000 persons treated) but a nonstatistically significant increase in major bleeding events (absolute increase, 1 event per 1000 persons treated) and no effect on mortality or symptomatic DVT. Hence, there is more benefit from potential reduction in PE events relative to the risk for bleeding.As far as the rating of our evidence goes, according to the GRADE system, publication bias is just one of the factors, including the number and quality of trials, consistency between trials, and precision of estimates, and others that should be considered when rating the quality of evidence and grading the strength of recommendations. Funnel plots can be helpful in understanding the risk for publication bias, but results must be interpreted cautiously because the small sample effects evaluated in funnel plots can be due to factors other than publication bias (such as differences in study quality, populations, or outcomes) (1, 2). Other approaches for examining the likelihood of publication bias have similar limitations (3). In addition, the possibility of publication bias by itself does not necessarily invalidate estimates of treatment effects. In this case, many unpublished small trials of heparin prophylaxis showing no reduced risk for PE would have to exist to lower the absolute decrease in events from 4 events per 1000 persons treated to 1 or fewer events per 1000 persons treated and result in no net benefit relative to the risk for major bleeding. This is unlikely. Therefore, we stand by our original recommendation and grading of evidence.As far as Dr. Cundiff's and Drs. Agutter and Malone's comments are concerned, our literature review only included evidence from randomized, controlled trials because they are less susceptible to bias than observational studies when designed and done correctly. Their review focused on diet and VTE and included no studies that actually evaluated the association between a prophylactic intervention and clinical outcomes. Rather, it discussed possible mechanisms for benefit and epidemiologic studies and proposed a possible dietary intervention for future research (4). Hence, this paper was not included in the review for our guideline.Amir Qaseem, MD, PhD, MHAAmerican College of PhysiciansPhiladelphia, PA 19106Roger Chou, MDLinda L. Humphrey, MD, MPHOregon Health and Science UniversityPortland, OR 97201Paul Shekelle, MD, PhDWest Los Angeles Veterans Affairs Medical CenterLos Angeles, CA 90073

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

Letters20 March 2012Venous Thromboembolism Prophylaxis in Hospitalized Medical PatientsPaul S. Agutter, MD, PhD and P. Colm Malone, MDPaul S. Agutter, MD, PhDFrom Theoretical Medicine and Biology Group, Glossop SK13 7RR, United Kingdom, and Birmingham B5 7UY, United Kingdom.Search for more papers by this author and P. Colm Malone, MDFrom Theoretical Medicine and Biology Group, Glossop SK13 7RR, United Kingdom, and Birmingham B5 7UY, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-6-201203200-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent review by Lederle and colleagues (1) supporting the ACP clinical guideline for hospitalized medical and stroke patients (2) showed that both low-molecular-weight and unfractionated heparin fail to reduce VTE mortality and deep venous thrombosis (DVT)–related morbidity in patients overall but increase the likelihood of major bleeding. Our recent article (3) yielded the same inferences but was surprisingly not cited in the guideline (2). Qaseem and colleagues recommend that for most patients, heparin prophylaxis should be used only when risk for VTE exceeds the risk for bleeding, but how these risks are computed and compared is ...

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

Extended Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: Risks vs. Benefits

Current practice guidelines recommend extended venous thromboembolism (VTE) prophylaxis in high-risk surgical patients, but its value is less clear in

Abstract 9832: Individualized Patient Education Program for Prevention of Venous Thromboembolism in Hospitalized Medical Patients

Introduction: Up to 15% of clinician-ordered doses of injectable prophylactic unfractionated or low-molecular weight heparin to prevent venous thromboembolism (VTE) are not administered. Patient refusal accounts for nearly 50% of these omitted doses. Hypothesis: We hypothesized that a pharmacist-led individualized patient education program will improve medication adherence to clinician-ordered doses of injectable prophylactic anticoagulation. Methods: Using our hospital's Electronic Health Record, we identified 528 hospitalized medical patients who were ordered for injectable pharmacological VTE prophylaxis. We evaluated the impact of pharmacist-led individualized patient education sessions, conducted within 24 hours of the initial order for prophylactic anticoagulation, on medication adherence (defined as the ratio of doses administered to doses scheduled). Results: Unfractionated heparin was the most frequent clinician-ordered injectable prophylactic anticoagulant (55%) followed by dalteparin (45%). Individualized patient education sessions were conducted within 24 hours of the first dose of prophylactic anticoagulation in 99% of patients. The patient education program improved adherence to clinician-ordered pharmacological VTE prophylaxis from 89.9% in our historical cohort to 94.4% (p<0.0001). The proportion of patients receiving 100% of scheduled doses of pharmacological prophylaxis increased from 82.8% to 91.9% (p=0.001). Patient refusal as a reason for omitted doses decreased from 43.7% to 29.3% after the patient education program (p=0.001). Conclusion: Pharmacist-led individualized patient education sessions improved medication adherence to clinician-ordered pharmacological VTE prophylaxis and reduced patient refusal as a cause of omitted doses. Efforts to enhance VTE prevention among hospitalized medical patients should focus on patient education to improve adherence to pharmacological VTE prophylaxis.

Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline

Venous thromboembolism prophylaxis has been recommended for nonsurgical patients, but its effectiveness remains uncertain. To assess the benefits and harms of prophylaxis in hospitalized adult medical patients and those with acute stroke. MEDLINE and the Cochrane Library from 1950 through April 2011, reference lists, and study authors. English-language randomized trials were included if they provided clinical outcomes and evaluated therapy with low-dose heparin or related agents or mechanical measures compared with placebo, no treatment, or other active prophylaxis in the target population. Two independent investigators extracted data on study characteristics and clinical outcomes up to 120 days after randomization. The primary outcome was total mortality. In medical patients, heparin prophylaxis did not reduce total mortality but did result in fewer pulmonary embolisms (PEs) (odds ratio [OR], 0.69 [95% CI, 0.52 to 0.90], but with evidence of publication bias) and an increase in all bleeding events (risk ratio [RR], 1.34 [CI, 1.08 to 1.66]). Heparin prophylaxis had no statistically significant effect on any outcome in patients with acute stroke except for an increase in major bleeding events (OR, 1.66 [CI, 1.20 to 2.28]). When trials of medical patients and those with stroke were considered together (18 studies; 36,122 patients), heparin prophylaxis reduced the incidence of PE (OR, 0.70 [CI, 0.56 to 0.87]; absolute reduction, 3 events per 1000 patients treated [CI, 1 to 5 events]) but increased the incidence of all bleeding (RR, 1.28 [CI, 1.05 to 1.56]) and major bleeding events (OR, 1.61 [CI, 1.23 to 2.10]), with an absolute increase of 9 bleeding events per 1000 patients treated (CI, 2 to 18 events), 4 of which were major (CI, 1 to 7 events). A reduction in total mortality approached statistical significance (RR, 0.93 [CI, 0.86 to 1.00]; P = 0.056; absolute decrease, 6 deaths per 1000 patients treated [CI, 0 to 11 deaths]). No statistically significant differences in clinical outcomes were observed in the 14 trials that compared unfractionated heparin with low-molecular-weight heparin. No improvements in clinical outcomes were seen in the 3 studies of mechanical prophylaxis in patients with stroke, but more patients had lower-extremity skin damage (RR, 4.02 [CI, 2.34 to 6.91])-an increase of 39 events per 1000 patients treated (CI, 17 to 77 events). Non-English-language studies were not included, but these were few and small. Heparin prophylaxis had no significant effect on mortality, may have reduced PE in medical patients and all patients combined, and led to more bleeding and major bleeding events, thus resulting in little or no net benefit. No differences in benefits or harms were found according to type of heparin used. Mechanical prophylaxis provided no benefit and resulted in clinically important harm to patients with stroke. American College of Physicians.

Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE

Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization. Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk. Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age > 60 years, lower-limb paralysis, immobilization ≥ 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score ≥ 1. During hospitalization, 31% had a score ≥ 2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score ≥ 4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score ≥ 2 was associated with higher overall and VTE-related mortality. Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation.

Prevalence of Risk Factors for VTE In Hospitalized Medical and Surgical Patients. Data From the Comparison of Methods for Thromboembolic Risk Assessment with Clinical Perceptions and AwareneSS In Real Life Surgical and Medical Patients (COMPASS) Study

AbstractAbstract 3337 Introduction:Risk assessment models (RAM) are helpful tools for the screening VTE risk in hospitalized patients. Most of the available RAMs have been constructed on a disease-based or surgery-based approach and include some of the most relevant risk factors for VTE. There is limited information on the impact and importance of individual and comorbidity related risk factors for VTE present during hospitalization on the global VTE risk. Incorporation of the most frequent VTE risk and bleeding risk factors related to comorbidities might improve the ability of RAM to detect real-life patients at risk VTE and to evaluate drawbacks for the application of thromboprophylaxis. Aim of the study:The primary aim of the COMPASS programme was to evaluate the prevalence of the all known VTE and bleeding risk factors reported in the literature in real-life surgical and medical hospitalized patients. Methods:A prospective multicenter cross-sectional observational study was conducted in 6 hospitals in Greece and 1 in France. All inpatients aged >40 years hospitalised for medical diseases and inpatients aged >18 years admitted due to a surgical procedure and hospitalisation for a period exceeding three days were included. Patients and their treating physicians were interviewed with standardised questionnaire including all VTE and bleeding risk factors described in literature (130 items) on the third day of hospitalisation. Patients not giving informed consent, or receiving anticoagulant treatment for any reason or hospitalised in order to undergo diagnostic investigation without any further therapeutic intervention were excluded. Results:A total of 806 patients were enrolled in the study (414 medical and 392 surgical). Most frequent causes of hospitalisation in medical patients were infection (42%), ischemic stroke (14%), cancer (13%), gastrointestinal disease (9%), pulmonary disease (4%), renal disease (3%) and rheumatologic disease (1,4%). Surgical patients were hospitalised for vascular disease (22%) cancer (19,4%) gastrointestinal disease (12,5%), infection (8%), orthopaedic surgery and trauma (14%) or minor surgery (7%). Analysis of the frequency of risk factors for VTE showed that active cancer, recent hospitalisation, venous insufficiency and total bed rest without bathroom privileges were frequent in both groups. Medical patients had significantly more frequently than surgical patients several important predisposing risk factors for VTE. Moreover, medical patient had more frequently than surgical ones bleeding risk factors. The data for the most frequent risk factors are summarised in Table 1. Conclusion:COMPASS is the first registry that provides key data on the prevalence of all known VTE and bleeding risk factors in real life medical and surgical patients hospitalised in two countries of European Union. The analysis of the data shows that in addition to risk stemin from the disease or surgical act both medical and surgical patients share common VTE risk factors. The careful analysis of the most frequent and relevant VTE risk factors will allow the derivation of a practical VTE and bleeding risk assessment model taken into account these factors. Disclosures:Chrysanthidis:Sanofi-Aventis: Employment.

Lack of Thromboprophylaxis Across the Care Continuum in US Medical Patients

Venous thromboembolism (VTE) prophylaxis is suboptimal, with many at-risk medical patients not receiving anticoagulants in hospital. Among those who receive anticoagulants in the hospital, thromboprophylaxis is frequently stopped at discharge despite persistent risk. Few studies have investigated prophylaxis use across the continuum of care. We analyzed anticoagulant use in medical patients in hospital and after discharge. Patient records (January 2005–December 2007) from medical patients with cancer, heart failure, severe lung disease, or infectious disease who were deemed at risk for VTE by the 2008 American College of Chest Physicians guidelines were included. Records were queried for inpatient and outpatient anticoagulant use by cross-matching data from the Premier Perspective™ discharge database with the i3/Ingenix LabRx outpatient and inpatient database. Of the 9675 medical patients identified, only 36.1% received inpatient anticoagulation (24.9% cancer patients, 30.1% infectious disease patients, 42.5% severe lung disease patients, and 56.3% heart failure patients). Of those who received in-hospital anticoagulants, most received enoxaparin (58.6%) followed by unfractionated heparin and other prophylactic agents. Only 1.8% of medical patients were prescribed anticoagulants within 30 days after discharge, ranging from 1.1% of patients with infectious disease to 4.8% of patients with heart failure. The majority of patients discharged who received outpatient anticoagulation filled prescriptions for warfarin, followed by enoxaparin plus warfarin. This real-world study demonstrates that only one-third of at-risk medical patients receive anticoagulants in hospital, with < 2% continuing to receive prophylaxis after discharge. Therefore, there is a need to improve the provision of thromboprophylaxis in the continuum of care for acutely ill medical patients.

Frequency and risk factors associated with emergency medical readmissions in Galway University Hospitals

Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH). Readmissions during the calendar year 2006 were examined using hospital in-patient enquiry data. Associations with clinical and demographic factors were determined using univariate and multivariate analyses. The medical emergency readmission rate to GUH, after correction for death during the index admission, was 19.5%. Age 65 years or more, male gender, length of stay more than 7 days and primary diagnoses of chronic obstructive pulmonary disease, myocardial infarction, alcohol-related disease and heart failure during the index admission were significantly associated with readmission in univariate and multivariate analyses. The medical emergency readmission rate in GUH is comparable to other acute hospitals in Ireland and Britain. Further evaluation is needed to estimate the proportion of readmissions that are potentially avoidable.

Economic and Practical Aspects of Thromboprophylaxis With Unfractionated and Low-Molecular-Weight Heparins in Hospitalized Medical Patients

Acutely ill medical patients are at significant risk of developing venous thromboembolic (VTE) complications during or after their hospitalization. Venous thromboembolic events, such as proximal deep vein thrombosis (DVT) or pulmonary embolism (PE), place a high and unacceptable burden on health care resources, up to US$1.5 billion annually in the United States. However, the burden of VTE can be reduced by use of appropriate thromboprophylaxis. Prophylaxis of VTE with either a low-dose unfractionated heparin (UFH) or a low-molecular-weight heparin (LMWH) in medical inpatients is effective, well tolerated and cost-effective, compared with no prophylaxis. Low-molecular-weight heparins have a number of practical benefits over UFH, including once-daily subcutaneous injection and the potential to be used in the outpatient setting. These clinical advantages could translate to improved patient adherence to therapy and provide economic benefits, where LMWHs are more cost-effective compared with UFH.

Improving Clinical Effectiveness in Thromboprophylaxis for Hospitalized Medical Patients

A 78-year-old woman with chronic obstructive pulmonary disease, history of deep vein thrombosis and obesity presents with dyspnea and hypoxemia. The physical examination findings of fever to 101.5°F, cough productive of thick yellow-green sputum, coarse expiratory wheezing and poor air movement, hyperinflation on chest radiograph, and hypercapnea on arterial blood gas confirm the diagnosis of chronic obstructive pulmonary disease exacerbation with superimposed bronchitis. She is admitted to the Medical Service for management.

Prevention of Venous Thromboembolism in Hospitalized Medical Patients

Venous thromboembolism (VTE) is a clinical disease entity which is manifested as deep venous thrombosis and/or pulmonary embolism. VTE presenting as pulmonary embolism (PE) is one of the leading causes of mortality and morbidity in the United States. Pulmonary embolism accounts for 5–10% of deaths in hospitalized patients, making VTE the most common preventable cause of in-hospital death. It appears that PE is more common in hospitalized medical patients than surgical patients, although medical patients are less likely to receive VTE prophylaxis. Up to 15% of hospitalized medical patients who do not receive thromboprophylaxis will develop symptomatic VTE. Fatal PE also seems to occur more frequently in medical rather than surgical patients. The economic burden of VTE is substantial. In 2004, the cost of a VTE occurring in hospital added over $18,000 USD to the median cost of an individual hospitalization and increased the length of stay by a median of almost 10 days. The costs associated with long-term management and chronic complications of VTE that arise after discharge from hospital are also significant. VTE prophylaxis is underused or applied incorrectly in medically ill hospitalized patients. This trend is certain to improve as external regulatory forces monitor physician practices and clinical outcomes. This review summarizes the large body of data on VTE risk factors, the efficacy and safety of pharmacologic and mechanical prophylaxis, and consensus guideline recommendations for primary in-hospital prophylaxis of medical patients.

Prophylaxis for Thromboembolism in Hospitalized Medical Patients

Prophylaxis for Thromboembolism in Hospitalized Medical Patients

Pharmacological Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients

There is uncertainty regarding which pharmacological agents most effectively prevent venous thromboembolism in hospitalized medical patients. We therefore performed a meta-analysis to determine this. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from 1950, 1966, and 1800, respectively, through June 30, 2006, for randomized controlled trials that involved medical patients comparing unfractionated heparin (UFH) or low-molecular-weight heparin or heparinoid (LMWH) with a control, LMWH with UFH, or selective factor Xa inhibitors with a comparator. Study selection, validity assessment, and data abstraction were performed by 2 independent reviewers (L.W. and S.W.). Data synthesis was undertaken by 1 blinded investigator (S.J.H.). Thirty-six studies were included. Compared with the control, UFH was associated with a reduced risk of deep venous thrombosis (DVT) (risk ratio [RR], 0.33; 95% confidence interval [CI], 0.26-0.42) and pulmonary embolism (RR, 0.64; 95% CI, 0.50-0.82), as was LMWH (RR, 0.56; 95% CI, 0.45-0.70; and RR, 0.37; 95% CI, 0.21-0.64, respectively). A UFH dosage of 5000 U 3 times daily was more effective in preventing DVT than a UFH dosage of 5000 U twice daily when compared with the control (RR, 0.27; 95% CI, 0.20-0.36; vs RR, 0.52; 95% CI, 0.28-0.96). Neither UFH nor LMWH reduced mortality. When directly compared with UFH, LMWH was associated with a lower risk of DVT (RR, 0.68; 95% CI, 0.52-0.88) and injection site hematoma (RR, 0.47; 95% CI, 0.36-0.62), but no difference was seen between the 2 agents in the risk of bleeding or thrombocytopenia. Both UFH and LMWH reduce venous thromboembolic risk in hospitalized medical patients, but neither agent alters mortality. When directly compared, LMWH is more effective in preventing DVT.

Prophylaxis for Thromboembolism in Hospitalized Medical Patients

Prophylaxis for Thromboembolism in Hospitalized Medical Patients