Anticoagulation Therapy Is Not Just for Surgical Patients

Acutely ill medical and even general medical patients can also benefit from anticoagulation therapy, Gail Macik, MD, associate professor of internal medicine and pathology, University of Virginia, Charlottesville, VA, reminded attendees at the American College of Physicians Annual Session.

"Low dose heparin and low molecular weight heparin (LMWH) reduce risk of symptomatic and asymptomatic VTE by at least 50% in a broad spectrum of medical patients without significant bleeding," she noted.

Nevertheless, some medical patients are more at risk for a deep vein thrombosis than others. Risk factors include cancer, congestive heart failure (CHF), chronic respiratory failure, limited mobility, obesity, age greater than 60 years, varicose veins, and a history of DVT and paralysis, she said.

Examples of the demonstrated benefit of anticoagulation therapy in medical patients include a heparin study in CHF patients. Four percent of patients given 5000 units of heparin three times a day had a VTE compared to 26% on placebo.

Also, in a study of low-dose molecular weight heparin (LMWH), patients on enoxaparin (40mg daily) had a 5.l% incidence of VTEs versus 14.9% on placebo. These general medical patients were all older than 40 and had at least one risk factor for VTE.

Dr. Macik also tells her medical students that thromboprophylaxis reduces overall costs and patient morbidity. "I tell them that it?s also easier to treat a patient prophylactically than to treat a patient with a VTE," she said.