VTE prophylaxis does not reduce bleeding, mortality in medically ill patients

Routine administration of venous thromboembolism (VTE) prophylaxis to medically ill patients at high risk for thrombosis significantly increases the risk of bleeding and has no clear clinical benefit, reveals a recent study, noting that the current practice must be reassessed.

This retrospective cohort study was carried out in a tertiary hospital in Israel to assess the benefit and safety of VTE prophylaxis in acutely ill medical patients hospitalized in medical departments with an admission lasting >48 hours during 2014–2017.

Thirty-day mortality was the primary outcome. Secondary outcomes included 90-day incidence of pulmonary embolism, symptomatic deep vein thrombosis, and major bleeding. The authors performed propensity-weighted logistic multivariate analysis.

Of the 18,890 patient-unique episodes analysed, 3,206 (17.0 percent) received prophylaxis. A total of 1,309 patients (6.9 percent) died, of whom 540/3,206 (16.8 percent) received VTE prophylaxis and 769/15,864 did not. Prophylaxis did not reduce mortality (multivariable-adjusted, propensity-weighted odds ratio (OR), 0.99, 95 percent confidence interval [CI], 0.84–1.14).

VTE occurred in 142 patients (0.7 percent), of whom 44/3,206 (1.4 percent) received prophylaxis and 98/15,864 (0.6 percent) did not. Prophylaxis did not correlate with a reduction in VTE in the whole cohort (multivariable-adjusted, propensity-weighted OR, 1.09, 95 percent CI, 0.52–2.29).

Notably, prophylaxis resulted in an increase in major bleeding (multivariable-adjusted, propensity-weighted OR, 1.24, 95 percent CI, 1.04–1.48).

“Current guidelines recommend pharmacologic prophylaxis for medical patients at high risk for VTE,” according to the authors.