Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients
Abstract Background Venous thromboembolism (VTE) accounts for an estimated 900,000 cases per year in the US alone and constitutes a considerable burden on healthcare systems across the globe. Objective To understand why the burden is so high, qualitative and quantitative research was carried out to...
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | Thrombosis Journal |
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| Online Access: | https://doi.org/10.1186/s12959-019-0214-8 |
| _version_ | 1818565141595160576 |
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| author | Benjamin Brenner Roopen Arya Jan Beyer-Westendorf James Douketis Russell Hull Ismail Elalamy Davide Imberti Zhenguo Zhai |
| author_facet | Benjamin Brenner Roopen Arya Jan Beyer-Westendorf James Douketis Russell Hull Ismail Elalamy Davide Imberti Zhenguo Zhai |
| author_sort | Benjamin Brenner |
| collection | DOAJ |
| description | Abstract Background Venous thromboembolism (VTE) accounts for an estimated 900,000 cases per year in the US alone and constitutes a considerable burden on healthcare systems across the globe. Objective To understand why the burden is so high, qualitative and quantitative research was carried out to gain insights from experts, guidelines and published studies on the unmet clinical needs and therapeutic strategies in VTE prevention and treatment in three populations identified as being at increased risk of VTE and in whom VTE prevention and treatment were regarded as suboptimal: pregnant women, the elderly and obese patients. Methodology A gap analysis methodology was created to highlight unmet needs in VTE management and to discover the patient populations considered most at risk. A questionnaire was devised to guide qualitative interviews with 44 thrombosis and haemostasis experts, and a review of the literature on VTE in the specific patient groups from 2015 to 2017 was completed. This was followed by a Think Tank meeting where the results from the research were discussed. Results This review highlights the insights gained and examines in detail the unmet needs with regard to VTE risk-assessment tools, biomarkers, patient stratification methods, and anticoagulant and dosing regimens in pregnant women, the elderly and obese patients. Conclusions Specifically, in pregnant women at high risk of VTE, low-molecular-weight heparin (LMWH) is the therapy of choice, but it remains unclear how to use anticoagulants when VTE risk is intermediate. In elderly patients, evaluation of the benefit of VTE prophylaxis against the bleeding risk is particularly important, and a head-to-head comparison of efficacy and safety of LMWH versus direct oral anticoagulants is needed. Finally, in obese patients, lack of guidance on anticoagulant dose adjustment to body weight has emerged as a major obstacle in effective prophylaxis and treatment of VTE. |
| first_indexed | 2024-12-14T01:37:25Z |
| format | Article |
| id | doaj.art-4a6e1d75488149bb87e79b6bb063002e |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-12-14T01:37:25Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-4a6e1d75488149bb87e79b6bb063002e2022-12-21T23:21:51ZengBMCThrombosis Journal1477-95602019-12-0117111510.1186/s12959-019-0214-8Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patientsBenjamin Brenner0Roopen Arya1Jan Beyer-Westendorf2James Douketis3Russell Hull4Ismail Elalamy5Davide Imberti6Zhenguo Zhai7Department of Hematology and Bone Marrow Transplantation, Rambam Health Care CampusKing’s Thrombosis Centre, Department of Haematological Medicine, King’s College Hospital Foundation NHS TrustThrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital ‘Carl Gustav Carus’ DresdenDepartment of Medicine, McMaster UniversityFoothills Medical Centre and Thrombosis Research Unit, University of CalgaryDepartment of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical UniversityHospital of PiacenzaDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory DiseasesAbstract Background Venous thromboembolism (VTE) accounts for an estimated 900,000 cases per year in the US alone and constitutes a considerable burden on healthcare systems across the globe. Objective To understand why the burden is so high, qualitative and quantitative research was carried out to gain insights from experts, guidelines and published studies on the unmet clinical needs and therapeutic strategies in VTE prevention and treatment in three populations identified as being at increased risk of VTE and in whom VTE prevention and treatment were regarded as suboptimal: pregnant women, the elderly and obese patients. Methodology A gap analysis methodology was created to highlight unmet needs in VTE management and to discover the patient populations considered most at risk. A questionnaire was devised to guide qualitative interviews with 44 thrombosis and haemostasis experts, and a review of the literature on VTE in the specific patient groups from 2015 to 2017 was completed. This was followed by a Think Tank meeting where the results from the research were discussed. Results This review highlights the insights gained and examines in detail the unmet needs with regard to VTE risk-assessment tools, biomarkers, patient stratification methods, and anticoagulant and dosing regimens in pregnant women, the elderly and obese patients. Conclusions Specifically, in pregnant women at high risk of VTE, low-molecular-weight heparin (LMWH) is the therapy of choice, but it remains unclear how to use anticoagulants when VTE risk is intermediate. In elderly patients, evaluation of the benefit of VTE prophylaxis against the bleeding risk is particularly important, and a head-to-head comparison of efficacy and safety of LMWH versus direct oral anticoagulants is needed. Finally, in obese patients, lack of guidance on anticoagulant dose adjustment to body weight has emerged as a major obstacle in effective prophylaxis and treatment of VTE.https://doi.org/10.1186/s12959-019-0214-8Venous thromboembolismElderlyPregnantPregnancyObeseObesity |
| spellingShingle | Benjamin Brenner Roopen Arya Jan Beyer-Westendorf James Douketis Russell Hull Ismail Elalamy Davide Imberti Zhenguo Zhai Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients Thrombosis Journal Venous thromboembolism Elderly Pregnant Pregnancy Obese Obesity |
| title | Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients |
| title_full | Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients |
| title_fullStr | Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients |
| title_full_unstemmed | Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients |
| title_short | Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients |
| title_sort | evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at risk patient groups pregnancy elderly and obese patients |
| topic | Venous thromboembolism Elderly Pregnant Pregnancy Obese Obesity |
| url | https://doi.org/10.1186/s12959-019-0214-8 |
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