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Innere Medizin 1. Juni 2009

Venous thromboembolism prophylaxis in hospitalized patients with pneumonia: a prospective survey

BACKGROUND: Guidelines for prevention of venous thromboembolism recognize pneumonia and changes in respiratory status as risk factors. There is little information on the preventive use of low-molecular-weight heparin (LMWH) in hospitalized patients with pneumonia. METHODS: We prospectively screened 1067 admissions to our hospital for preventive use of LMWH according to the American College of Chest Physicians (ACCP) guidelines. The analysis included 168 patients with pneumonia (age 74 ± 16 years, 56% men). The primary and secondary outcomes were treatment with LMWH in eligible patients and LMWH use according to guidelines (daily dose, duration of treatment). RESULTS: LMWH use was indicated in 126 (75%) patients and 119 (94%) were actually treated. In 41% of patients treatment was according to the ACCP guidelines. The dose and duration of LMWH treatment were appropriate in 61% and 66% of patients, respectively. Non-use of LMWHs was not associated with clinical and demographic characteristics. Adverse effects included bleeding (N = 7) and thrombocytopenia (N = 2) but were not associated with fatality. Prolonged treatment with LMWH was associated with adverse effects (P < 0.05). CONCLUSIONS: Implementation of LMWH prophylaxis for venous thromboembolism in hospitalized patients with pneumonia reached 94%. Adherence to ACCP guidelines was complete in 41% of patients. Prolonged treatment with LMWH was associated with non-fatal adverse effects, which calls for timely withdrawal of LMWH once no longer indicated.

Petra Jancar, Tina Morgan, Ales Mrhar, Mitja Kosnik, Mitja Lainscak, Wiener klinische Wochenschrift 9/10/2009

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