[Evidence-based guidelines for prevention and therapy of venous thromboembolism].
Recently, evidence-based guidelines for the prevention and therapy of venous thromboembolism have been published. Prophylaxis: in General Surgery patients with moderate to severe risk need to be treated with unfractioned (UFH) or low molecular weight (LMWH) heparin. Non pharmacological methods must be reserved to patients with high hemorrhagic risk and in association to heparin to patients with particularly high thromboembolic risk. In high risk Ortopedic Surgery prophylaxis with high doses LMWH or oral anticoagulants (OA) is indicated. Il Neurosurgical Surgery and in politraumatized patients prophylaxis must be individualized taking account of hemorrhagic risk; patients with acute medullary lesion with paraplegia must be treated with LMWH. In Internal Medicine conditions which determine prolonged bed rest need prophylaxis with UFH or LMWH. In pregnancy, pharmacological prophylaxis is indicated only in cases of preceding thrombotic events or documented congenital risk factors.


METHODS
deep venous thrombosis or sub-massive pulmonary embolism must be treated with anticoagulant doses of UFH or LMWH (100 U antiXa/Kg twice daily). OA must be continued for a time identifiable on the basis of underlying disease. In massive or sub-massive pulmonary embolism with hemodynamic instability thrombolysis is indicated. In heparin induced thrombocytopenia alternative antithrombotic treatments must be employed.
Falciani
M
M
Scuola di Specializzazione in Medicina Interna, Istituto di Clinica Medica e Cardiologia, Azienda Ospedaliera Careggi, Università degli Studi, Firenze.
Dilaghi
B
B
Conti
A A
AA
Caciolli
S
S
Gensini
G F
GF
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000517:prevention & control / Q000628:therapy; D011655:Pulmonary Embolism / Q000517:prevention & control / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use; D017131:Thrombectomy; D013921:Thrombocytopenia / Q000139:chemically induced; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000188:drug therapy / Q000628:therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; C006871:calcium heparin; D006493:Heparin; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator