An update on prevention of venous thromboembolism in hospitalized acutely ill medical patients

In the absence of thromboprophylaxis, the incidence of venous thromboembolism (VTE) ranges from 10–20% in general medical patients to 80% in trauma patients, spinal cord injury patients, and patients in the critical care unit [1,2]. Despite evidence from large, randomized clinical studies demonstrating the benefits of providing thromboprophylaxis for hospitalized medical patients at risk of VTE [3-5], thromboprophylaxis is not currently prescribed to the extent that might be expected in this patient population, leaving many patients exposed to significant risk of acute thrombotic complications and their long-term consequences [6-9].Consensus guidelines published by the American College of Chest Physicians (ACCP) and the International Union of Angiology (IUA) recommend assessment of all hospitalized medical patients for the risk of VTE and the provision of appropriate thromboprophylaxis [1,2]. Furthermore, simple and clinically-relevant risk assessment models (RAMs) are available to facilitate VTE risk assessment [10,11]. A recently published evidence-based RAM, developed specifically for hospitalized medical patients, should provide additional guidance to physicians in this patients group [12]. This RAM integrates patient VTE risk level with appropriate thromboprophylactic strategies in the form of a management algorithm. Computerised reminders have also been shown to be valuable for improving prophylaxis prescribing rates [13], and an electronic risk assessment tool has recently been developed for use in medical patients as well as surgical patients [14].The recently updated ACCP consensus guidelines give a grade 1A recommendation for thromboprophylaxis using either low-molecular-weight heparin (LMWH) or low-dose unfractionated heparin (UFH) in medical patients with congestive heart failure (CHF) or severe respiratory disease, or in medical patients who are confined to bed and have one or more risk factors for VTE, such as active malignancy, acute neurological dise