Original Articles
Vol. 4 No. 3 (2025)
Still unmet problems with low molecular weight heparin prophylaxis of venous thromboembolism. An Italian survey
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 3 October 2025
19
Views
11
Downloads
Authors
Background: a survey was launched to assess the challenges that Italian patients and physicians face with home prophylaxis using low-molecular-weight heparin (LMWH), promoted by the "Arianna Anticoagulazione" Foundation, Bologna, Italy.
Methods: conducted between March and October 2024, the survey targeted readers of the "anticoagulazione.it" website, distributed through a newsletter and social media. There were two different surveys, one addressed to patients\caregivers and the other to physicians.
Results: the professional survey revealed significant uncertainties about managing chronic patients, with over half of physicians identifying them as a "gray area." A third of clinicians were unsure about the duration and necessity of home prophylaxis for acute patients. Arbitrary suspension of treatment was reported by a significantly lower proportion of patients\caregivers than professionals (4% vs 38%; p<0.0001).
Conclusions: home prophylaxis presents challenges, especially for chronic patients, acute patients treated at home, and those with specific conditions (e.g., renal insufficiency or extreme body weight). The lack of clear guidelines and the widespread use of LMWH outside standard recommendations highlights the need for large-scale clinical trials to address these issues. Discrepancy in compliance reported by patients\caregivers and clinicians underline the need for improved professional-patient communication.
Downloads
Download data is not yet available.
Citations
1. Heit JA, Silverstein MD, Mohr DN, et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001;86:452-63. DOI: https://doi.org/10.1055/s-0037-1616243
2. Oger E. Incidence of venous thromboembolism: A community-based study in western France. Thromb Haemost 2000;83:657-60. DOI: https://doi.org/10.1055/s-0037-1613887
3. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016;41:3-14. DOI: https://doi.org/10.1007/s11239-015-1311-6
4. White RH. The epidemiology of venous thromboembolism. Circulation 2003;107:I4-I8. DOI: https://doi.org/10.1161/01.CIR.0000078468.11849.66
5. Amin A, Neuman WR, Lingohr-Smith M, et al. Venous thromboembolism prophylaxis and risk in the inpatient and outpatient continuum of care among hospitalized acutely ill patients in the US: a retrospective analysis. Adv Ther 2019;36:59-71. DOI: https://doi.org/10.1007/s12325-018-0846-2
6. Spencer FA, Lessard D, Emery C, et al. Venous thromboembolism in the outpatient setting. Arch Intern Med 2007;167:1471-5. DOI: https://doi.org/10.1001/archinte.167.14.1471
7. Sweetland S, Green J, Liu B, et al. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ 2009;339:b4583. DOI: https://doi.org/10.1136/bmj.b4583
8. Baimas-George MR, Ross SW, Yang H, et al. Just what the doctor ordered: missed ordering of venous thromboembolism chemoprophylaxis is associated with increased VTE events in high-risk general surgery patients. Ann Surg 2023;278:e614-e9. DOI: https://doi.org/10.1097/SLA.0000000000005779
9. Eck RJ, Elling T, Sutton AJ, et al. Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: systematic review and network meta-analysis. BMJ 2022;378:e070022. DOI: https://doi.org/10.1136/bmj-2022-070022
10. Pannucci CJ, Swistun L, MacDonald JK, et al. Individualized venous thromboembolism risk stratification using the 2005 Caprini score to identify the benefits and harms of chemoprophylaxis in surgical patients: a meta-analysis. Ann Surg 2017;265:1094-103. DOI: https://doi.org/10.1097/SLA.0000000000002126
11. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010;8:2450-7. DOI: https://doi.org/10.1111/j.1538-7836.2010.04044.x
12. Spyropoulos AC, Anderson FA, Jr., Fitzgerald G, et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest 2011;140:706-14. DOI: https://doi.org/10.1378/chest.10-1944
13. Goldhaber SZ. DVT prevention: What is happening in the ''real world''? Semin Thromb Hemost 2003;29:23-31. DOI: https://doi.org/10.1055/s-2003-45414
14. Amin A, Spyropoulos AC, Dobesh P, et al. Are hospitals delivering appropriate VTE prevention? The venous thromboembolism study to assess the rate of thromboprophylaxis (VTE start). J Thromb Thrombolysis 2010;29:326-39. DOI: https://doi.org/10.1007/s11239-009-0361-z
15. Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational crosssectional study. Lancet 2008;371:387-94. DOI: https://doi.org/10.1016/S0140-6736(08)60202-0
16. Dexter PR, Perkins S, Overhage JM, et al. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001;345:965-70. DOI: https://doi.org/10.1056/NEJMsa010181
17. Kucher N, Puck M, Blaser J, et al. Physician compliance with advanced electronic alerts for preventing venous thromboembolism among hospitalized medical patients. J Thromb Haemost 2009;7:1291-6. DOI: https://doi.org/10.1111/j.1538-7836.2009.03509.x
18. Fanikos J, Stevens LA, Labreche M, et al. Adherence to pharmacological thromboprophylaxis orders in hospitalized patients. Am J Med 2010;123:536-41. DOI: https://doi.org/10.1016/j.amjmed.2009.11.017
19. Shermock KM, Lau BD, Haut ER, et al. Patterns of non-administration of ordered doses of venous thromboembolism prophylaxis: implications for novel intervention strategies. PLoS One 2013;8:e66311. DOI: https://doi.org/10.1371/journal.pone.0066311
20. Louis SG, Sato M, Geraci T, et al. Correlation of missed doses of enoxaparin with increased incidence of deep vein thrombosis in trauma and general surgery patients. JAMA Surg 2014;149:365-70. DOI: https://doi.org/10.1001/jamasurg.2013.3963
21. Khorfan R, Kreutzer L, Love R, et al. Association between missed doses of chemoprophylaxis and VTE incidence in a statewide colectomy cohort. Ann Surg 2021;273:e151-e2. DOI: https://doi.org/10.1097/SLA.0000000000004349
22. Lau BD, Streiff MB, Kraus PS, et al. Missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals: cause for Alarm. J Gen Intern Med 2018;33:19-20. DOI: https://doi.org/10.1007/s11606-017-4203-y
23. Colwell CW Jr, Collis DK, Paulson R, et al. Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty - Evaluation during hospitalization and three months after discharge. J Bone Joint Surg Am 1999;81: 932-40. DOI: https://doi.org/10.2106/00004623-199907000-00005
24. White RH, Romano PS, Zhou H, et al. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med 1998;158:1525-31. DOI: https://doi.org/10.1001/archinte.158.14.1525
25. Spyropoulos AC, Ageno W, Albers GW, et al. Post-discharge prophylaxis with rivaroxaban reduces fatal and major thromboembolic events in medically ill patients. J Am Coll Cardiol 2020;75:3140-7. DOI: https://doi.org/10.1016/j.jacc.2020.04.071
26. Kripalani S, Jackson AT, Schnipper JL, et al. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2007;2:314-23. DOI: https://doi.org/10.1002/jhm.228
27. Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007;297:831-41. DOI: https://doi.org/10.1001/jama.297.8.831
28. Amin A, Stemkowski S, Lin J, et al. Thromboprophylaxis rates in US medical centers: success or failure? J Thromb Haemost 2007;5:1610-6. DOI: https://doi.org/10.1111/j.1538-7836.2007.02650.x
29. Colwell CW, Jr., Pulido P, Hardwick ME, et al. Patient compliance with outpatient prophylaxis: an observational study. Orthopedics 2005;28:143-7. DOI: https://doi.org/10.3928/0147-7447-20050201-16
30. Bergqvist D, Arcelus JI, Felicissimo P. Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery: results from the ETHOS registry. Thromb Haemost 2012;107:280-7. DOI: https://doi.org/10.1160/TH11-07-0464
31. Wilke T, Moock J, Muller S, et al. Nonadherence in outpatient thrombosis prophylaxis with low molecular weight heparins after major orthopaedic surgery. Clin Orthop Relat Res 2010;468:2437-53. DOI: https://doi.org/10.1007/s11999-010-1306-8
32. Karlinski M, Stolarczyk A, Siuda M, et al. Compliance with low molecular weight heparin in ambulatory orthopedic patients. Ortop Traumatol Rehabil 2006;8:633-8.
33. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e195S-e226S. DOI: https://doi.org/10.1378/chest.11-2296
34. Schunemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018;2:3198-225. DOI: https://doi.org/10.1182/bloodadvances.2018022954
35. Anderson DR, Morgano GP, Bennett C, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv 2019;3:3898-944. DOI: https://doi.org/10.1182/bloodadvances.2019000975
How to Cite
1.
Cavazza S, Palareti G. Still unmet problems with low molecular weight heparin prophylaxis of venous thromboembolism. An Italian survey. Bleeding Thromb Vascul Biol [Internet]. 2025 Oct. 3 [cited 2025 Oct. 7];4(3). Available from: https://www.btvb.org/btvb/article/view/177
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Giovanni Tiscia, Elvira Grandone, Talking about assisted reproductive techniques and thromboembolic risk: everything we always wanted to know , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Jingnan Huang, Delia I. Fernández, Jinmi Zou, Xueqing Wang, Johan W.M. Heemskerk, Ángel García, Restrained glycoprotein VI-induced platelet signaling by tyrosine protein phosphatases independent of phospholipase Cγ2 , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Bianca Clerici, Mariangela Scavone, Gian Marco Podda, Recent advances in classic heparin-induced thrombocytopenia (HIT), autoimmune HIT, spontaneous HIT, and vaccine-induced immune thrombotic thrombocytopenia , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 2 (2024)
- Marcello Baroni, Paolo Ferraresi, Nicole Ziliotto, Daria Bortolotti, Pierfilippo Acciarri, Nicola Martinelli, Giovanna Marchetti, Matteo Coen, Francesco Bernardi, Protein S on the surface of plasma lipoproteins: a potential mechanism for protein S delivery to the atherosclerotic plaques? , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Benedetta Izzi, Simona Costanzo, Alessandro Gialluisi, Amalia De Curtis, Sara Magnacca, Teresa Panzera, Augusto Di Castelnuovo, Maria Benedetta Donati, Chiara Cerletti, Marc F. Hoylaerts, Giovanni de Gaetano, Licia Iacoviello, *on behalf of the Moli-sani Study Investigators, Platelet distribution width is associated with cardiovascular mortality in an adult general population , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Rita Carlotta Santoro, Roberto Minici, Marzia Leotta, Mariapia Falbo, Lucia Concetta Elia, Francesca Leo, Antonella Ierardi, Alessandra Strangio, Simona Prejanò, Vaccine-induced immune thrombotic thrombocytopenia following ChAdOx1 nCoV-19 vaccine: report of two cases , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Bianca Rocca, Emma Hansson, Milan Milojevic, Anders Jeppsson, 2024 EACTS guidelines on perioperative medication in adult cardiac surgery: embracing precision medicine driven by strong evidence-based methodology , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 2 (2025)
- Boris Shenkman, Ivan Budnik, Yulia Einav, Interaction between adenosine diphosphate receptors and protein-kinase C isoforms in platelet adhesion under flow condition , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 1 (2023)
- Daniela Poli, Emilia Antonucci, Gualtiero Palareti, Roberto Facchinetti, Pietro Falco, Giuseppina Serricchio, Teresa Lerede, Lucilla Masciocco, Paolo Gresele, Sophie Testa, Major bleedings in mechanical prosthetic heart valves patients on Vitamin K antagonist treatment. Data from the PLECTRUM Study , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Massimo Franchini, Polycythemia vera and management of the thrombotic risk: an update , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 4 (2023)
You may also start an advanced similarity search for this article.
