Risk of Venous Thromboembolism in Long-Term Care Residents: What Do We Know Now?

The article by Barbara Zarowitz and colleagues¹ on the risk of venous thromboembolism (VTE) in long-term care (LTC) is a brave attempt to stratify thrombotic risk in LTC. Their systematic review of more than 8 years of data identified a total of 1165 publications relating to VTE and immobility. Rating these publications according to accepted quality criteria resulted in selection of 4 articles relating to thrombotic risk, and 1 article (1 of these 4, actually) relating to immobility. Eight mobility-related statements and 30 VTE risk statements were derived from these articles. The authors' final recommendations (reached by modified Delphi method of analysis of the mobility and VTE risk statements) include baseline thrombotic risk screening on admission; prophylaxis for up to 35 days if high risk; then consideration of prophylaxis indefinitely if the risks and mobility are not sufficiently improved. Recommendations for VTE prophylaxis is not within the scope of the article. However, the vast majority of controlled trials in the past 5 to 10 years has focused on low molecular weight heparins (LMWH) or factor Xa inhibitors. The recommendations of the American College of Chest Physicians (ACCP) guidelines² for high-risk patients includes an LMWH or factor Xa inhibitor as either a first or second choice for anticoagulant thromboprophylaxis. ACCP recommends against sole use of aspirin or mechanical methods of thromboprophylaxis in general.