HHS – full or prophylactic anticoagulation?
AbstractDiabetes mellitus and, in particular, the hyperosmolarity associated with the hyperosmolar hyperglycaemic state (HHS) is associated with an increased risk of thrombotic events. This risk is acknowledged by the authors of the national HHS guideline who recommend prophylactic low molecular weight heparin (LMWH) for all patients with HHS for the full duration of their admission.
We present a case of fatal pulmonary embolism in a 39-year old man admitted with HHS who was treated according to local hospital trust and national guidance with prophylactic LMWH.
In the absence of evidence from randomised studies comparing prophylactic and treatment dose anti- coagulation in thrombosis prevention in HHS further research is needed to facilitate development of evidence-based guidelines.
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