At-home pharmacologic prophylaxis of thrombosis in immobilized patients

Mark Crowther, MD, MSc, is a professor of medicine, chair of the Department of Medicine, and Leo Pharma Chair in Thromboembolism Research at McMaster University.

Pharmacologic prophylaxis of thrombosis in immobilized patients staying at home raises many doubts. Are there situations when it should be used?

This is a really interesting question. Should we use pharmacologic prophylaxis outside the hospital? I would say that we use it extraordinarily infrequently. The reason is it’s costly and complex to administer, but also there’s no evidence that it’s effective.

However, if you have a critically ill patient in the hospital, there’s no question that prophylaxis reduces the risk of venous thromboembolism (VTE). So if you had a similarly ill patient at home, I have no doubt that prophylaxis would reduce the risk of VTE.

The question then becomes, is the cost and complexity of administering this therapy worth the outcome? And we just don’t know because the studies haven’t been done. So I can say confidently that I have never used hospital-like prophylaxis in a person at home except in exceptional circumstances. I think in general we would not recommend its use simply because it is almost impossible to deliver.