ABSTRACT
In medical patients, the risk of venous thromboembolism (VTE) is substantially underestimated
and prophylaxis is used far less than in surgical patients, reflecting the scarcity
of evidence supporting antithrombotic therapy in nonsurgical settings. However, current
consensus documents recommend assessment of all medical, as well as surgical, patients
for thromboembolic risk and provide prophylaxis recommendations according to the risk
level, determined by the presence of different clinical and molecular risk factors.
Although long-term, underlying clinical and molecular risk factors also have a major
impact on overall risk in medical patients; risk clearly varies with the type of medical
condition. Myocardial infarction, stroke, and malignant disease are linked to a high
rate of VTE; recent evidence highlights patients with cardiopulmonary disease as a
distinct risk group. Despite skepticism in some quarters, high-quality evidence confirms
the efficacy of unfractionated heparin (UFH) and low-molecular-weight heparins (LMWH)
in reducing asymptomatic deep vein thrombosis (DVT) in a broad spectrum of medical
patients; further studies are required to clarify the effect on fatal pulmonary embolism
(PE). Emerging data from the recent PRINCE and MEDENOX studies demonstrate that the
LMWH enoxaparin provides effective and well-tolerated VTE prevention in patients with
severe cardiopulmonary disease. Emerging evidence has led to a grade 1A recommendation
for the use of thromboprophylaxis in these patients in the most recent consensus conference
on thromboprophylaxis. Further studies, however, are required to clarify the optimal
duration of prophylaxis in medical patients and to evaluate the potential role of
outpatient prophylaxis. Accurate risk assessment and prompt implementation of appropriate
prophylaxis, selected on the basis of evidence from well-designed controlled clinical
trials, may reduce the future morbidity and mortality due to VTE in medical patients.
KEYWORD
Venous thrombosis - pulmonary embolism - medical patients - thromboprophylaxis - low-molecular-weight
heparins
