Has time come for the use of direct oral anticoagulants in the extended prophylaxis of venous thromboembolism in acutely ill medical patients?
In recent years, the burden of VTE in hospitalized medical patients has shifted to the post-hospital discharge period. The shortened hospital length of stay (LOS) has dampened treatment effects of in-hospital thromboprophylaxis. Recent studies report that the risk of symptomatic VTE persist after discharge [1, 2]. With shorter hospitalization (4–5 days), in-hospital prophylaxis may not be enough, and an extended prophylaxis may be necessary. It has been demonstrated that VTE risk can extend up to 90 days (peak 35–45 days) after index hospitalization .
Moreover, with the aging of the population with multiple comorbidities, some patients do not make it to the hospital unless they are really sick, and are more likely to be managed as outpatients. We therefore have to identify who should receive extended prophylaxis at home. Patient-related morbidities increase VTE risk [1, 4], and intrinsic patient risk factors have an additive, if not a multiplicative impact on the risk of the VTE.
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Authors declare that they have no conflict of interest.
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This article does not contain any studies with human participants or animals performed by any of the authors.