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Risk Factors for Venous Thromboembolism in Hospitalized Patients With Acute Medical Illness
Analysis of the MEDENOX Study
Raza Alikhan, BSc, MBBS;
Alexander T. Cohen, MBBS, MSc, MD, FRACP;
Sophie Combe, MD;
Meyer M. Samama, MD, PhD;
Louis Desjardins, MD;
Amiram Eldor, MD;
Charles Janbon, MD;
Alain Leizorovicz, MD, PharmD;
Carl-Gustav Olsson, MD;
Alexander G. G. Turpie, MD, FRCP
Arch Intern Med. 2004;164:963-968.
Background There is limited information about risk factors for venous thromboembolism (VTE) in acutely ill hospitalized general medical patients.
Methods An international, randomized, double-masked, placebo-controlled trial (MEDENOX) has previously been conducted in 1102 acutely ill, immobilized general medical patients and has shown the efficacy of using a low-molecular-weight heparin, enoxaparin sodium, in preventing thrombosis. We performed logistic regression analysis to evaluate the independent nature of different types of acute medical illness (heart failure, respiratory failure, infection, rheumatic disorder, and inflammatory bowel disease) and predefined factors (chronic heart and respiratory failure, age, previous VTE, and cancer) as risk factors for VTE.
Results The primary univariate analysis showed that the presence of an acute infectious disease, age older than 75 years, cancer, and a history of VTE were statistically significantly associated with an increased VTE risk. Multiple logistic regression analysis indicated that these factors were independently associated with VTE.
Conclusions Several independent risk factors for VTE were identified. These findings allow recognition of individuals at increased risk of VTE and will contribute to the formulation of an evidence-based risk assessment model for thromboprophylaxis in hospitalized general medical patients.
From the Academic Department of Surgery, Guy's, King's, and St Thomas' School of Medicine, London, England (Drs Alikhan and Cohen); Département Cardiovasculaire, Laboratoires Rhône-Poulenc Rorer, Montrouge, France (Dr Combe); Département d'Hématologie Biologique, Hôtel Dieu, Paris, France (Dr Samama); Service d'Hématologie, Centre Hospitalier Université Laval, St Foy, Quebec (Dr Desjardins); Institute of Hematology, Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel (Dr Eldor); Service de Médecine Interne, Centre Hospitalier Université Hôpital Saint-Eloi, Montpellier, France (Dr Janbon); Service de Pharmacologie Clinique, University of Lyon, Lyon, France (Dr Leizorovicz); Internal Medicine Department, University Hospital of Lund, Lund, Sweden (Dr Olsson); and the Department of Medicine, McMaster University, Hamilton, Ontario (Dr Turpie). The authors have no relevant financial interest in this article. Dr Eldor is deceased.
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