{ event: "article_read", name: `Unmet clinical needs in the management of VTE in at-risk patients`, author: ``, tags: `Thrombosis`, publication_date: ``, interaction_type: "content" }
Unmet clinical needs in the management of VTE in at-risk patients
Unmet clinical needs in the management of venous thromboembolism in at-risk patients
Review suggests inconsistency of recommendations and paucity of precise risk assessment tools and biomarkers.
Main Takeaway
Low-molecular-weight heparin (LMWH) is the anticoagulant of choice in pregnant women and obese patients for venous thromboembolism (VTE) prophylaxis; however, LMWH dose adjustment is a significant problem in these patients.
In elderly, LMWH showed a better safety and efficacy profile than unfractionated heparin (UFH) for thromboprophylaxis; however, the benefit of VTE prophylaxis needs to be evaluated against the bleeding risk.
In high-risk patients, guideline recommendations are inconsistent and physician’s views are heterogeneous on VTE prophylaxis.
This review highlights the need for the development of user-friendly, population-adapted VTE risk assessment tools and clinically valuable biomarkers.
Study Design
In this study, a gap analysis was performed to highlight unmet needs in VTE management and discover the high-risk patients.
44 key opinion leaders from 12 different countries or regions were interviewed with a pre-determined questionnaire.
A comprehensive literature search was conducted on VTE in the specific patient groups (pregnant women, elderly and obese patients) during 2015-2017.
Findings from the qualitative and quantitative research were discussed in a Thrombosis Think Tank meeting in 2018.
Funding: Editorial assistance was supported by Sanofi.
Key Results
Management of VTE during pregnancy and post-partum:
LMWH is the preferred anticoagulant for prophylaxis and treatment of VTE during pregnancy, but there is an inconsistency in the ideal LMWH dose.
Experts agreed that anti-Xa monitoring for LMWH dosing in pregnant women at very high risk is widely used and likely beneficial.
Effects of direct oral anticoagulants (DOACs) on the foetus or the newborn child are currently unknown.
A history of VTE or heritable thrombophilia is an established risk factor of VTE during pregnancy.
Predictive utility of all conventional and candidate VTE biomarkers is unclear during pregnancy and puerperium.
Guidelines and opinions differ on risk stratification, duration of prophylaxis and the safety of DOACs during pregnancy.
Development of more precise risk assessment tools and biomarkers is needed.
Management of VTE in elderly:
LMWH showed a better safety and efficacy profile over UFH for thromboprophylaxis in elderly.
Although DOACs are considered convenient in elderly patients outside the hospital setting, safety remains unclear.
The experts agreed on careful benefit-risk assessments during thromboprophylaxis.
Drug compliance, bleeding risks and co-morbidities should be considered while prescribing thromboprophylaxis.
The experts noted disparities in risk assessment guidance and thromboprophylaxis practice across countries.
Management of VTE in obese patients:
The interviewed physicians prefer LMWHs over DOACs for thromboprophylaxis in obese patients.
The efficacy and safety of DOACs have not been adequately investigated for thromboprophylaxis.
Clinical practice guidelines highlight the need for the development of dosing regimens.
However, it is uncertain whether dose adjustment should be based on weight, body mass index or a fixed-dose regimen.
Majority of experts agree on LMWH dose adjustment based on patient’s weight
Brenner B, Arya R, Beyer-Westendorf J, Douketis J, Hull R, Elalamy I, Imberti D, Zhai Z. Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients. Thromb J. 2019;17:24. doi: 10.1186/s12959-019-0214-8. PMID: 31889915.
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