Extended Thromboprophylaxis in Medically Ill Patients

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Patients who are hospitalized for medical illness remain at risk for venous thromboembolism after discharge, but the role of extended thromboprophylaxis in the treatment of such patients is a subject of controversy.

This webinar aims to discuss the benefits and risks of extended thromboprophylaxis in acute medically ill patients with a focus on the recently published MARINER study.


Alex Spyropoulos

Alex Spyropoulos

Gary E Raskob

Gary E Raskob

Key Learning Objectives

  • Describe the risk of venous thromboembolism (VTE) following hospital discharge in the acutely medical ill.
  • Identify acutely medical ill patients at significant risk for VTE after hospital discharge.
  • Evaluate the recent MARINER trial, Rivaroxaban for Thromboprophylaxis After Hospitalization for Medical Illness, in context to previously published trials on extended VTE prophylaxis.
  • Identify the benefits and risks of current therapies for extended VTE prophylaxis.

Target Audience

  • Cardiology, Hospital Medicine, Pulmonary, Infectious Disease
  • Endocrinology, Stroke Neurology
  • Critical Care
  • Internal and Family Medicine
  • Nurse Practitioners and Mid-levels in Hospital Medicine

Faculty Biographies

Alex Spyropoulos

Alex Spyropoulos

Dr Alex C. Spyropoulos obtained his medical degree from the University of Pennsylvania School of Medicine in Philadelphia, PA, USA. He completed his internship and residency in internal medicine at the University of New Mexico Health Sciences Center in Albuquerque, NM. 

Dr Spyropoulos was founder and former Medical Director of the Clinical Thrombosis Center in Albuquerque, New Mexico. He is a Professor of Medicine at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and System Director of Anticoagulation and Clinical Thrombosis Services for the multi hospital Northwell Health in NY. He is also a Professor of the Merinoff Center for Patient-Oriented Research as part of the Feinstein Institutes for Medical Research. He is co-chair of the Council on Leadership of Thrombosis at Northwell Health. He is a Fellow of the American College of Physicians, American College of Chest Physicians, International Academy of Clinical and Applied Thrombosis/Haemostasis, and the Royal College of Physicians, Canada.

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Gary E Raskob

Gary E Raskob

Gary E Raskob's research and scholarly interests are in the prevention, diagnosis and treatment of deep-vein thrombosis and pulmonary embolism; the clinical development of antithrombotic drugs; clinical trials; prevention research; evidence-based medicine; and the translation of research evidence into practice and health policy.

Gary E Raskob has participated extensively in clinical practice guideline development for several specialty organizations including the American Society of Hematology, the American College of Chest Physicians, the American Thoracic Society, and the American Society of Clinical Oncology. He also serves as an advisor on thrombosis and hemostasis for the U.S. National Heart, Lung, and Blood Institute, and the Centers for Disease Control and Prevention. Gary E Raskob is author or coauthor of more than 200 publications on the prevention, diagnosis and treatment of thromboembolic disease, including 16 articles in the New England Journal of Medicine.

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Key References

1. Spyropoulos AC, Ageno W, Albers GW, Elliott CG, Halperin JL, Hiatt WR, Maynard GA, Steg PG, Weitz JI, Suh E, Spiro TE, Barnathan ES, Raskob GE; MARINER Investigators. Rivaroxaban for thromboprohylaxis after hospitalization for medical illness N Engl J Med 2018 379(12):1118-1127.

2. Spyropoulos AC, Raskob CE. New paradigms in venous thromboprophylaxis of medically ill patients Thromb Haemost 2017; 117(9): 1162-1670.

3. Gibson CM, Spyropoulos AC, Cohen AT, Hull RD, Goldhaber SZ, Yusen RD, Hernandez AF, Korjian S, Daaboul Y, Gold A, Harrington RA, Chi G. The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk Stratification. TH Open 2017;1:e56–e65.

4. Cohen AT, Spiro TE, Buller HR, Haskell L, Hu D, Hull R, Mebazaa A, Merli G, Schellong S, Spyropoulos AC, Tapson V. Rivaroxaban for the prevention of venous thromboembolism in acutely-ill medical patients: the MAGELLAN study N Engl J Med 2013; 368:513-23.

5. Cohen AT, Spiro TE, Spyropoulos AC, Honda Y, Homering M, Buller HR, Haskell L, Hu D, Mebazza A, Merli G, Schellong S, Tapson VF, Burton P. D-dimer as a predictor of venous thromboembolism in acutely-ill hospitalized medical patients: A sub-analysis of the randomized controlled MAGELLAN trial J Thromb Haemost 2014; 12(4):479-87.

6. Cohen AT, Harrington RA, Goldhaber Sz, et al. Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med 2016; 375:534-44.

7. Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 2011; 365: 2167-77.

8. Spyropoulos AC, Anderson FA, FitzGerald G, Decousus H, Pini M, Chong BH, MD, PhD, Zotz RB, Bergmann JF, for the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) Investigators. A predictive model to identify hospitalzed medical patients at risk of venous thromboembolism Chest 2011 14(3):706-714.

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