Venous thromboembolism in patients undergoing surgery: Low rates of prophylaxis and high rates of filter insertion

2007 ◽  
Vol 98 (12) ◽  
pp. 1220-1225 ◽  
Author(s):  
Ali Seddighzadeh ◽  
Urszula Zurawska ◽  
Ranjith Shetty ◽  
Samuel Goldhaber
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
The United States ◽  
Surgical Patients ◽  
Major Surgery ◽  
Utilization Rate ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Presenting Symptoms ◽  
Ivc Filters

SummaryPatients who undergo surgery are at a high risk of developing venous thromboembolism (VTE). To further define the demographics, comorbidities, and risk factors of VTE in patients undergoing major surgery, we analyzed 1,375 hospitalized non-orthopedic surgery patients in a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Extremity edema (67.9%), extremity discomfort (44.9%), and dyspnea (18.9%) were among the most common presenting symptoms among these surgical patients. Compared to medical patients, surgical patients presented with a more occult clinical picture and complained less often of extremity edema (67.9% vs. 73.7%; p=0.0001), extremity discomfort (44.9% vs. 56.4%; p<0.0001), or difficulty walking (6.6% vs. 11.2%; p<0.0001). Immobility within 30 days of DVT diagnosis, prior hospitalization within 30 days of DVT diagnosis, presence of an indwelling central venous catheter, obesity (BMI >30 kg/m2), and previous smoking were the most common VTE risk factors among surgical patients. Among surgical patients who developed DVT, some form of prophylaxis had been used in only 44%. Once diagnosed with DVT, surgical patients received IVC filters more often than medical patients (20.0% vs. 14.1%; p<0.0001; adjusted OR=1.49, 95% CI=1.17–1.92; p<0.001). In conclusion, VTE prophylaxis remains underutilized in surgical patients. The IVC filter utilization rate in surgical patients is significantly higher than in medical patients. Future studies should focus on devising mechanisms to improve implementation of prophylaxis and investigate the long-term safety and efficacy of IVC filters in surgical patients.

The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE): Venous Thromboembolism Prophylaxis Practices in Acutely Ill Medical Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1762-1762 ◽  
Author(s):  
Victor F. Tapson ◽  
Herve Decousus ◽  
Jean-Fran[ccedi]ois Bergmann ◽  
Beng H. Chong ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Major Surgery ◽  
Medical Illness ◽  
Medical Patients ◽  
Median Length ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Elastic Stockings

Abstract Background Despite consensus group recommendations indicating that medical patients should receive appropriate venous thromboembolism (VTE) prophylaxis, prophylaxis practices remain poorly characterized. This analysis of IMPROVE, a prospective study of acutely ill medical patients, describes in-hospital prophylaxis practices prior to the publication of updated VTE prevention guidelines by the American College of Chest Physicians. Methods Patient recruitment began in July 2002. Patients ≥18 years old, and hospitalized for ≥3 days with an acute medical illness are enrolled consecutively. Exclusion criteria are: therapeutic antithrombotics/thrombolytics at admission; major surgery or trauma during 3 months prior to admission; and VTE treatment begun within 24 hours of admission. Results Data were from 4315 patients (32% from USA) enrolled up to 30 June 2004 in 37 hospitals in 11 countries (76% with 3-month follow-up data). Patients are 50% female, median (IQR) age 69 (50–80) years, median length of hospital stay 8 (5–14) days, median weight 68 (58–80) kg, and 40% were immobile for ≥3 days (median length of immobility 7 [4–14] days, including immobility immediately prior to admission). In-hospital VTE prophylaxis was received by 41% of patients (Table 1). Of patients with no risk factors (44%), one risk factor (40%), or ≥2 risk factors (16%), 25%, 49%, and 67% received prophylaxis, respectively. 12% of IMPROVE patients would have been eligible for inclusion in the MEDENOX study. Of these, only 52% received prophylaxis in hospital. Prophylaxis was provided to 6% of patients during the 3-month follow-up period, and continued in 11% of patients after discharge. Conclusions Only 41% of IMPROVE patients received VTE prophylaxis, with considerable variation in types and regimens of prophylaxis used. While MEDENOX showed the benefits of VTE prophylaxis (enoxaparin 40 mg) in acutely ill medical patients, only half of MEDENOX-eligible patients received prophylaxis. Table 1. Use of in-hospital VTE prophylaxis (N=4315) VTE prophylaxis Patients receiving VTE prophylaxis, % ROW, rest of world; *Excluding elastic stockings and aspirin ≥1 type of VTE prophylaxis* 41 LMWH - USA (Q12h, Qd) 7 (5, 1) LMWH- ROW (Q12h, Qd) 31 (29, 2) UFH - USA (Q12h, Q8h) 28 (15, 11) UFH - ROW (Q12h, Q8h) 6 (5, 0) Intermittent pneumatic compression (USA, ROW) 6 (19, 0) Aspirin (USA, ROW) 4 (7, 3) Elastic stockings (USA, ROW) 6 (3, 8)

Impact of Postoperative Venous Thromboembolism on Postoperative Morbidity, Mortality, and Resource Utilization after Hepatectomy

2015 ◽  
Vol 81 (12) ◽  
pp. 1216-1223 ◽  
Author(s):  
Timothy E. Newhook ◽  
Damien J. Lapar ◽  
Dustin M. Walters ◽  
Shruti Gupta ◽  
Joshua S. Jolissaint ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Fold Increase ◽  
The United States ◽  
Albumin Level ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Resource Usage ◽  
Vte Prophylaxis ◽  
The Impact

The impact of venous thromboembolism (VTE) after hepatectomy on patient morbidity, mortality, and resource usage remains poorly defined. Better understanding of thromboembolic complications is needed to improve perioperative management and overall outcomes. About 3973 patients underwent hepatectomy within NSQIP between 2005 and 2008. Patient characteristics, operative features, and postoperative correlates of VTE were compared with identify risk factors for VTE and to assess its overall impact on postoperative outcomes. Overall incidence of postoperative VTE was 2.4 per cent. Risk factors for postoperative VTE included older age, male gender, compromised functional status, degree of intraoperative blood transfusion, preoperative albumin level (all P < 0.05), and extent of hepatectomy ( P = 0.004). Importantly, major postoperative complications, including acute renal failure, pneumonia, sepsis, septic shock, reintubation, prolonged ventilation, cardiac arrest, and reoperation were all associated with higher rates of VTE (all P < 0.05). Operative mortality was increased among patients with VTE (6.5% vs 2.4%, P = 0.03), and patients with VTE had a 2-fold increase in hospital length of stay (12.0 vs 6.0 days, P < 0.001). Postoperative VTE remains a significant source of morbidity, mortality, and increased resource usage after hepatectomy in the United States. Routine aggressive VTE prophylaxis measures are imperative to avoid development of VTE among patients requiring hepatectomy.

scholarly journals Risk assessment and prevention of venous thromboembolism among hospitalized patients: Results of the regional multicenter study

2021 ◽  
pp. 26-40
Author(s):  
A. B. Sugraliyev ◽  
Sh. S. Aktayeva ◽  
Sh. B. Zhangelova ◽  
S. A. Shiller ◽  
Zh. M. Kussymzhanova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Multicenter Study ◽  
Bed Rest ◽  
Primary Objective ◽  
Hospitalized Patients ◽  
Public Health Issue ◽  
Medical Patients ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis

Introduction. Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multicenter study was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the regions of Kazakhstan.Materials and methods. Standardized case report forms were filled by trained medical doctors on one predefined day in selected hospitals. Data were analyzed by independent biostatistician. Risk of VTE was categorized according to Caprini score which was recommended by 2004 American College of Chest Physicians (ACCP) guidelines.Results. 432 patients from 4 regions of Kazakhstan; 169 (39.10%) medical patients and 263 (60.9%) surgical patients were eligible for the study. Patients were at low (10%), moderate (19.2%), high (33.6%) and very high risk (37.3%) for VTE. The main risk factors (RF) of VTE among hospitalized patients were heart failure (HF), obesity, prolonged bed rest, and the presence of acute non-infective inflammation. From total number of hospitalized patients with RF with indications to VTE prophylaxis, 58.1% of patients received pharmacological prophylaxis and only 24.6% of them received VTE prophylaxis according ACCP. On the other hand, 23.5% patients with the risk of VTE but who were not eligible for it received pharmacological prophylaxis.Conclusion. These results indicate the existence of inconsistency between eligibility for VTE prophylaxis on one hand and its application in practice (p < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.

Identification of Medical Patients Who Should Receive Venous Thromboembolism Prophylaxis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1786-1786
Author(s):  
Alexander T. Cohen ◽  
Raza Alikhan ◽  
Juan I. Arcelus ◽  
Jean-François Bergmann ◽  
Sylvia Haas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Respiratory Disease ◽  
Strong Evidence ◽  
Medical Patient ◽  
Evidence Based ◽  
Medical Patients ◽  
Related Factors ◽  
Vte Prophylaxis ◽  
History Of

Abstract Introduction Despite various medical illnesses/conditions and patient-related factors known to increase venous thromboembolism (VTE) risk in medical patients, there is no worldwide consensus regarding which of these patients should receive VTE prophylaxis. As a result, many medical patients remain at risk from this potentially fatal disease. Our objective was to develop a simple risk assessment model (RAM) that could be used at the bedside to identify medical patients who should receive prophylaxis. Methods Acute medical illnesses/conditions and risk factors were included in the RAM if there was strong evidence from prospective clinical studies to show that they significantly increase VTE risk in medical patients, or VTE prophylaxis was beneficial in these cases. If strong evidence was not available, the illness/condition or factor was only included if there was consensus from the authors that VTE prophylaxis is beneficial for these patients. Results Table 1 shows acute medical illnesses/conditions and factors associated with significant VTE risk that are included in the RAM. If a medical patient is >40 years old with an acute medical illness and reduced mobility and has one of the illnesses/conditions or factors shown in Table 1, the RAM recommends prophylaxis with low-molecular-weight heparin (LMWH: enoxaparin 40 mg o.d. or dalteparin 5000 IU o.d.) or unfractionated heparin (5000 IU q8h). LMWH is preferred due to a better safety profile. If pharmacologic prophylaxis is contraindicated, mechanical prophylaxis is recommended. Conclusion Acute medical illnesses/conditions and patient-related factors that increase the risk for VTE in medical patients have been identified and used to develop a novel RAM. The RAM is evidence-based wherever possible, and can be easily revised as new evidence becomes available. The RAM is simple in design, and can assist physicians to assess whether VTE prophylaxis is warranted in an individual medical patient. Table 1. Factors that increase the risk of VTE in medical patients Acute medical illnesses/conditions Risk factors *Note: The risk of hemorrhagic transformation should be assessed before giving VTE prophylaxis. Evidence-based: Acute MI, acute heart failure (NYHA III/IV), active cancer requiring therapy, severe infection/sepsis, respiratory disease (respiratory failure with/without mechanical ventilation, exacerbation of chronic respiratory disease), rheumatic disease (including acute arthritis of lower extremities, and vertebral compression), ischemic stroke*, paraplegia Consensus view only: Inflammatory disorder with immobility, inflammatory bowel disease Evidence-based: History of VTE, history of malignancy, concurrent acute infectious disease, age >75 years Consensus-based from strong evidence in other settings: Prolonged immobility, age >60 years, varicose veins, obesity, hormone therapy, pregnancy/postpartum, nephrotic syndrome, dehydration, thrombophilia, thrombocytosis

Rates of venous thromboembolism occurrence in medical patients among the insured population

2009 ◽  
Vol 102 (11) ◽  
pp. 951-957 ◽  
Author(s):  
Mohamed Hussein ◽  
Jay Lin ◽  
David Battleman ◽  
Alex Spyropoulos
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Primary Diagnosis ◽  
Severe Form ◽  
World Population ◽  
Medical Patients ◽  
Post Discharge ◽  
Vte Prophylaxis

SummaryThe burden of venous thromboembolism (VTE) remains high in the United States (US). This study assesses the rate of VTE prophylaxis in a large real-world population of medically ill patients and identifies factors which confer VTE risk to this population. Discharges from the PharMetrics database were included if they were aged ≥40 years and had a hospitalisation claim (Jan 2001-Dec 2005) for cancer, congestive heart failure (CHF), severe infectious disease (SID), or lung disease. Discharges with incomplete records in the prior year to the index hospitalisation claim date were excluded. VTE rate, type (deep venous thrombosis [DVT] or pulmonary embolism [PE]), and time to VTE were compared between groups. Multivariate logistic regression analysis was used to identify independent predictors of VTE occurrence. A total of 158,325 patients were included in the study. Cancer patients had the highest incidence of VTE (7.6%), with the average for all patients being 5.6% (1.5% PE).VTE occurred most frequently post discharge, with the median time being 74 days. Post-discharge prophylaxis was provided to 13.1% of CHF patients and < 5% of all other patients. Independent predictors of VTE included a pre-index VTE (odds ratio [OR] 9.06, 95% confidence interval [CI] 8.28–9.91) and a primary diagnosis of cancer compared with a diagnosis of SID (OR 1.34, 95% CI 1.24–1.46). In conclusion, commercially insured medical patients in the US are at high risk of VTE following hospital discharge. One-quarter of medical patients who developed a VTE are at high risk of developing the more severe form of the disease, namely PE, with independent predictors of VTE in the postdischarge period including previous VTE and cancer.

Venous Thromboembolism Prevention with LMWHs in Medical and Orthopedic Surgery Patients

2003 ◽  
Vol 37 (3) ◽  
pp. 402-411 ◽  
Author(s):  
Steven B Deitelzweig ◽  
Gordon J Vanscoy ◽  
Cynthia S Niccolai ◽  
Thomas L Rihn
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Orthopedic Surgery ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Efficacy And Safety ◽  
Consensus Guidelines ◽  
Medline Search ◽  
Vte Prophylaxis

OBJECTIVE: To discuss the role of low-molecular-weight heparins (LMWHs) in the prevention of venous thromboembolism (VTE) in medical and orthopedic surgery patients. VTE prophylaxis trials in these practice settings establishing the current use of LMWHs marketed in the US are included. An overview is also provided of VTE incidence, risk factors, and prophylaxis consensus guidelines. DATA SOURCES AND STUDY SELECTION: Clinical trials, review articles, and meta-analyses for Food and Drug Administration–approved LMWHs were identified from a MEDLINE search (1980–March 2002). Search terms included dalteparin, enoxaparin, internal medicine, low-molecular-weight heparin, orthopedic surgery, risk factors, tinzaparin, and venous thromboembolism. DATA SYNTHESIS: Consensus guidelines are useful as an initial guide to appropriate VTE prophylaxis; however, a review of the primary literature is needed to identify optimal agents, regimens, or interventions. LMWHs have demonstrated sound efficacy in VTE prevention; however, the quantity and quality of literature are not always comparable for the available agents. CONCLUSIONS: Enoxaparin has demonstrated efficacy and safety in VTE prevention in medical patients, whereas information is limited or lacking for dalteparin and tinzaparin. Total hip replacement (THR) trials have been conducted with all US-marketed LMWHs and have demonstrated the efficacy and safety of each agent. Trials specifically establishing the efficacy of an LMWH in total knee replacement surgery (TKR) have been published for enoxaparin. One combination THR and TKR trial has been published for tinzaparin. These trial outcomes have positioned the LMWHs as key alternatives to adjusted-dose warfarin for VTE prophylaxis in orthopedic surgery. Inherent differences between LMWHs prevent the extrapolation of clinical outcomes from 1 trial to another.

Time Course of Venous Thromboembolism Events and Influence of Risk Factors in High Risk Medical Patients,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4182-4182
Author(s):  
Russell D Hull ◽  
Tazmin Merali ◽  
Allan Mills ◽  
Jane Liang ◽  
Nelly Komari
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Time Course ◽  
Diagnostic Testing ◽  
Real Life ◽  
High Risk Population ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
The Mean

Abstract Abstract 4182 Background: Venous thromboembolism (VTE) prophylaxis has been identified in clinical guidelines as an appropriate strategy for high-risk medical inpatients as it results in reduced VTE events and reduced mortality. However, real life data regarding the timing of VTE events and the relationship between risk factors and VTE in this population is lacking. Further knowledge of the time course of recurrence and influence of risk factors in actual practice may help clinicians determine strategies regarding the frequency of clinical surveillance and the appropriate duration of treatment. Objective: To document the time course of symptomatic VTE events in high-risk medical patients in every day clinical practice and to relate the frequency of risk factors to the likelihood of VTE development. Methods: Charts from 1134 consecutive high-risk medical patients who were hospitalized in the Calgary region and discharged between January and February 2008 were abstracted using standardized case record forms. All hospitals in the region use a common unique patient identifier number, thus enabling the tracking of subsequent patient visits to the emergency room, inpatient admissions or outpatient visits occurring anywhere in the region's acute care system. Any identified patient was followed for a subsequent visit related to VTE. High-risk medical patients were defined as age > 60 years and having at least one of the following risk factors: malignancy, respiratory illness, neurological illness, inflammatory bowel disease, previous VTE, acute infection or heart failure. Records were excluded if the patient was admitted for VTE or to rule out VTE, receiving chronic anticoagulation, experiencing acute coronary syndromes, had a hospital stay ≤ 3 days, was a surgical or orthopedic patient, or pregnant. Data was collected on the timing of VTE related events for up to 100 days post discharge. Results: A total of 989 patients met criteria over the review period. Seventy-four percent (732/989) of all patients received mechanical or pharmacological prophylaxis in hospital. Only 2% (95% CI, 1.6% to 3.6%) of all patients received anticoagulation prophylaxis at discharge. Twenty-one percent of patients in the population studied were identified as requiring medical care for symptoms associated with VTE. Confirmation of VTE by diagnostic testing occurred in 4% (95% CI, 2.7% to 5.2%) while the other 17% (95% CI, 15.0% to 19.8%) had diagnostic tests that were negative or inconclusive. The mean length of time to confirmed first VTE event was 33.5 days. Eighty percent of first events occurred by day 57 and 90% of first VTE events occurred by day 69 post hospital admission. Patients with more than 2 risk factors had a rate of confirmed symptomatic VTE events of 6.1%, increasing to 8.7% for those with more than 3 risk factors while only 2.9% of patients with 2 or less risk factors developed a confirmed VTE. (p=0.015) Conclusion: This study demonstrates that in a real life setting, 6% of those hospitalized medical patients with more than 2 risk factors would develop symptomatic VTE event confirmed by diagnostic testing, increasing to 8.7% for those with more than 3 pre-specified risk factors. The mean time to first VTE event of 33.5 days along with 80% of VTE events occurring by day 57 suggest that more consideration needs to be given to prolonged VTE prophylaxis in this high risk population. The frequency and timing of the VTE events coupled with the results of the EXCLAIM study suggest that this high risk population may benefit from prolonged thromboprophylaxis. Disclosures: Hull: LEO Pharma: Consultancy; sanofi-aventis: Consultancy; Pfizer: Consultancy; Portola: Consultancy; Merck: Consultancy; Bayer: Consultancy; Johnson & Johnson: Consultancy. Merali:LEO Pharma: Consultancy; Genzyme: Consultancy; Boehringer Ingelheim: Consultancy; Abbott: Consultancy; BMS: Consultancy; Pfizer: Consultancy; Amgen: Consultancy; sanofi-aventis: Consultancy; Nycomed: Consultancy; Otsuka: Consultancy. Mills:Pfizer: Consultancy; sanofi-aventis: Research Funding. Komari:sanofi-aventis: Employment.

scholarly journals Estimation of Acutely Ill Medical Patients at Venous Thromboembolism Risk Eligible for Extended Thromboprophylaxis Using APEX Criteria in US Hospitals

2019 ◽  
Vol 25 ◽  
pp. 107602961988000 ◽  
Author(s):  
Anne-Céline Martin ◽  
Wei Huang ◽  
Samuel Z. Goldhaber ◽  
Russell D. Hull ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Venous Thromboembolism ◽  
The United States ◽  
Care Hospital ◽  
Medical Patients ◽  
Hospital Discharges ◽  
Increased Risk ◽  
History Of ◽  
History Of Cancer

Major medical illnesses place patients at risk of venous thromboembolism (VTE). Some risk factors including age ≥75 years or history of cancer place them at increased risk of VTE that extends for at least 5 to 6 weeks following hospital admission. Betrixaban thromboprophylaxis is now approved in the United States for this indication. We estimated the annual number of acutely ill medical patients at extended risk of VTE discharged from US hospital. Major medical illnesses (stroke, respiratory failure/chronic obstructive pulmonary disease, heart failure, pneumonia, other infections, and rheumatologic disorders) and 2 common risk factors for extended VTE risk, namely, age ≥75 years and history of cancer (active or past) were examined in 2014 US hospital discharges using the first 3 discharge diagnosis codes in the National Inpatient Sample (database of acute-care hospital discharges from the US Agency for Health Care Quality and Research). In 2014, there were 20.8 million discharges with potentially at risk of nonsurgical-related VTE. Overall, 7.2 million (35%) discharges corresponded to major medical illness that warranted thromboprophylaxis according to 2012 American College of Chest Physicians (ACCP) guideline. Among them, 2.79 million were aged ≥75 years and 1.36 million had a history of cancer (aged 40-74 years). Overall, 3.48 million discharges were at extended risk of VTE. Many medical inpatients at risk of VTE according to 2012 ACCP guideline might benefit from the awareness of continuing risk and some of these patients might benefit from extended thromboprophylaxis, depending on the risk of bleeding and comorbidities.

scholarly journals Contemporary approach to primary prophylaxis of venous thromboembolism regarding the impact of risk factors on anticoagulation therapy duration

2014 ◽  
Vol 142 (3-4) ◽  
pp. 249-256
Author(s):  
Nebojsa Antonijevic ◽  
Ljubica Jovanovic ◽  
Valentina Djordjevic ◽  
Ivana Zivkovic ◽  
Miodrag Vukcevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Venous Thromboembolism ◽  
Anticoagulation Therapy ◽  
Chronic Obstructive ◽  
Medical Illness ◽  
Medical Patients ◽  
Class Iii ◽  
Vte Prophylaxis ◽  
The Impact

Adequate thromboprophylaxis primarily requires timely detection of reversible and irreversible risk factors of venous thromboembolism (VTE) and their categorization. It is important to note that the highest percentage of VTE episodes occur in non-surgical (medical) patients and that VTE develops in a large number of surgical patients upon hospital discharge; this emphasizes the need for adequate VTE prevention in inflammatory diseases, acute medical illness and other medical diseases as well as for prolonging and optimizing the anticoagulant regimen after surgical intervention in the primary VTE prophylaxis. As almost completely unrecognized and neglected major risk factors of VTE in clinical practice, we particularly point out the chronic obstructive pulmonary disease (COPD) and heart failure, especially in NYHA functional class III and IV patients with significantly reduced left heart ventricle. It is necessary to raise clinicians? awareness of a potential danger from wrongly and one-sidedly interpreted dyspnea and coughing signs in patients with COPD as typical symptoms of basic respiratory disease as well as from ascribing the signs of disease aggravation in heart failure patients exclusively to cardial status worsening, neglecting the possibility of having unrecognized and untreated pulmonary embolism at issue. Contemporary way of life enhances the development of new VTE risk factors such as traveler?s thrombosis, in particular during long-haul flights as well as in individuals sitting at a computer for prolonged periods (e-thrombosis). Determining and recognizing VTE risk factors, especially those formerly neglected nonsurgical ones and simultaneous presence of multiple risk factors within a given period is required for defining an adequate anticoagulant regimen in primary VTE prophylaxis for surgical and non-surgical (medical) patients.

Scoring Systems for Estimating Risk of Venous Thromboembolism in Hospitalized Medical Patients

2017 ◽  
Vol 43 (05) ◽  
pp. 460-468 ◽  
Author(s):  
Paolo Prandoni ◽  
Sofia Barbar
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Scoring Systems ◽  
Cost Effective ◽  
Assessment Model ◽  
Medical Patients ◽  
Thrombotic Risk ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Medical Inpatients

AbstractDeep vein thrombosis and pulmonary embolism are associated with considerable morbidity and mortality in hospitalized patients, accounting for up to 10% of hospitalization-related deaths in both surgical and medical patients. Pharmacologic thromboprophylaxis has been demonstrated to be effective, safe, and cost-effective in preventing hospital-acquired venous thromboembolism (VTE) among medical inpatients, and clinician awareness of thrombotic risk promotes prescription of thromboprophylaxis. Guidelines recommend stratification of thrombotic risk for all patients and, unless contraindicated, administration of VTE prophylaxis. Based on several recognized predisposing and exposing risk factors for VTE, several scoring systems have been published in the past 15 years. Borrowing models developed in the surgical setting, recognized risk factors for VTE complications in medical inpatients have been combined in different weighted scores and derived and validated in heterogeneous medical populations. Although the perfect score, balancing thrombotic and hemorrhagic risk, has probably not yet been built, the adoption of an easy-to-use risk assessment model has the potential to support physicians in properly stratifying VTE risk in medical inpatients, tailoring thromboprophylaxis prescription.

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