Prescription of low-molecular-weight heparin for venous thromboembolism prophylaxis in medical patients

OBJECTIVE: The aim of this prospective study was to observe the prescriptio n of low-molecular weight heparin (LMWH) for the prophylaxis of venous thro mboembolic disease in medical patients. METHODS: We included all the patients on LMWH prophylaxis in 5 medical depa rtments of Sainte-Marguerite Hospital in Marseille. The study described the reasons for this prophylaxis, the thrombotic risk, the follow-up quality a nd the side-effects. RESULTS: During four months, 189 (14.3%) of 1317 medical patients have rece ived a prophylaxis with LMWH; sixty one per cent of them were older than 70 years. Thrombotic risk as measured with Thilly's score was low in 50 patie nts (26%), moderate in 81 patients (43%), high in 58 patients (31%). Platel et count follow-up was optimal in 88 patients (47%). A decrease of plate le t count over 30%, reaching less than 100 G/I, was recorded in 4 patients. A venous thrombosis was diagnosed clinically in one patient Two patients had an overt severe bleeding. A serious hidden bleeding was suspected in 11 pa tients. CONCLUSION: LMWH were frequently prescribed for the prophylaxis of venous t hromboembolic disease in medical patients. Most of these patients were over 70 years of age. Platelet count follow-up was in accordance with guideline s in less than half of the patients. Bleedings were not rare on this treatm ent The present work suggests that a precise thrombotic risk assessment is needed before the onset of this therapy and that the association with aspir in should be careful.