Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients

Alexander T. Cohen; Raza Alikhan; Juan I. Arcelus; Jean-François Bergmann; Sylvia Haas; Geno J. Merli; Alex C. Spyropoulos; Victor F. Tapson; Alexander G. G. Turpie

doi:10.1160/TH05-06-0385

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 94(04): 750-759
DOI: 10.1160/TH05-06-0385

Review Article

Schattauer GmbH

Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients

Alexander T. Cohen

¹Guy’s, King’s and St Thomas’ School of Medicine, London, UK

,

Raza Alikhan

²John Radcliffe Hospital, Oxford, UK

,

Juan I. Arcelus

³University of Granada Medical School and Hospital San Juan de Dios, Granada, Spain

,

Jean-François Bergmann

⁴Hôpital Lariboisière, Paris, France

,

Sylvia Haas

⁵Technical University of Munich, Munich, Germany

,

Geno J. Merli

⁶Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, PA, USA

,

Alex C. Spyropoulos

⁷Lovelace Medical Center, Albuquerque, NM, USA

,

Victor F. Tapson

⁸Duke University Medical Center, Durham, NC, USA

,

Alexander G. G. Turpie

⁹Hamilton Health Sciences General Hospital, Hamilton, Ontario, Canada

› Author Affiliations

Abstract

Summary

Hospitalized patients with acute medical conditions are at significant risk of venous thromboembolism (VTE): approximately 10–30% of general medical patients may develop deep-vein thrombosis or pulmonary embolism, and the latter is a leading contributor to deaths in hospital. Despite consensus-group recommendations that at-risk medical patients should receive thromboprophylaxis, there is currently no consensus as to which patients are at risk, and many patients may not receive appropriate thromboprophylaxis. This paper reviews evidence for the risk of VTE associated with different medical conditions and risk factors, and presents a risk-assessment model for risk stratification in medical patients. Medical conditions associated with a moderate to high risk of VTE include cardiac disease, cancer, respiratory disease, inflammatory bowel disease, and infectious diseases. Importantly, analyses of data from the MEDENOX study show that thromboprophylaxis significantly reduces the risk o f VTE in these patient subgroups. Risk factors in medical patients include a history of VTE, history of malignancy, increasing age, thrombophilia, prolonged immobility, and obesity. These medical conditions and risk factors are included in a risk-assessment model which is hoped will provide a simple means of assisting clinicians in deciding whether thromboprophylaxis should be used in an individual patient.

Keywords

Medical illness - risk-assessment model - thromboprophylaxis - venous thromboembolism

Full Text

References

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