Extended venous thromboprophylaxis in patients hospitalized for acute ischemic stroke: A systematic review and meta-analysis.

Autor: Valeriani E; Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Italy. Electronic address: e.valeriani@unicampus.it., Potere N; Department of Innovative Technologies in Medicine and Dentistry, 'G. D'Annunzio' University, Chieti, Italy., Candeloro M; Department of Innovative Technologies in Medicine and Dentistry, 'G. D'Annunzio' University, Chieti, Italy; Department of Medicine and Ageing Sciences, 'G. D'Annunzio' University, Chieti, Italy., Spoto S; Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Italy., Porreca E; Department of Innovative Technologies in Medicine and Dentistry, 'G. D'Annunzio' University, Chieti, Italy., Rutjes AW; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland., Di Nisio M; Department of Medicine and Ageing Sciences, 'G. D'Annunzio' University, Chieti, Italy; Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of internal medicine [Eur J Intern Med] 2022 Jan; Vol. 95, pp. 80-86. Date of Electronic Publication: 2021 Oct 11.
DOI: 10.1016/j.ejim.2021.09.016
Abstrakt: Introduction: Patients hospitalized for acute ischemic stroke have an increased risk of venous thromboembolism (VTE) that may persist beyond the currently recommended period of 6 to 14 days of thromboprophylaxis. This systematic review evaluated the efficacy and safety of extended venous thromboprophylaxis in patients hospitalized for acute ischemic stroke.
Materials and Methods: MEDLINE, EMBASE and Clinicaltrials.gov were searched up to December 2020 for randomized controlled trials comparing extended versus standard venous thromboprophylaxis in patients hospitalized for acute ischemic stroke. The efficacy outcome was a composite of asymptomatic or symptomatic deep vein thrombosis, symptomatic pulmonary embolism, and VTE-related death. The safety outcome was major bleeding. Summary risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated using random-effects models.
Results: Four randomized controlled trials enrolling 33718 patients were included. Of 4330 (12.8%) patients hospitalized for acute ischemic stroke, 2152 (49.7%) received extended thromboprophylaxis for four to five weeks with betrixaban (n = 405, 18.8%), enoxaparin (n = 198, 9.2%), or rivaroxaban (n = 1549, 72.0%), and 2178 (50.3%) received standard venous thromboprophylaxis with enoxaparin. VTE risk was lower in acute ischemic stroke patients receiving extended thromboprophylaxis (RR 0.67; 95% CI, 0.43 to 1.04; 13 fewer per 1000), whereas the increase in major bleeding seemed trivial when compared with standard prophylaxis (RR 1.10; 95% CI, 0.31 to 3.95; 1 more per 1000).
Conclusion: In patients hospitalized for acute ischemic stroke, the net clinical benefit may favor extended venous thromboprophylaxis for four to five weeks over standard thromboprophylaxis.
(Copyright © 2021. Published by Elsevier B.V.)
Databáze: MEDLINE
Externí odkaz: