[Risk of venous thromboembolism in acute medical illnesses. Part 2: Situations at risk in ambulatory, hospital and internal medicine settings].
OBJECTIVE
The increased risk of thromboembolism in acute medical illnesses (AMI) is difficult to assess because of the diversity of medical conditions. The first part of this review of the literature was dedicated to methods of risk analysis based on our current pathophysiological knowledge. This second part describes more specifically the risk of venous thrombosis linked to AMI in hospital, ambulatory and internal medicine settings.


BACKGROUND
The incidence of venous thromboembolism is higher in hospital than in ambulatory setting, albeit the latter remains significant. Stroke and affections leading to intensive care management represent conditions at great risk. Several mechanisms leading to a prothrombotic state have been identified, explaining the increased risk observed during relapses of pathologies specifically treated in internal medicine such as lupus erythematosus, Wegener granulomatosis, inflammatory bowel diseases and Behcet's disease.


CONCLUSIONS
Next to the pathophysiological understanding of venous thrombosis, the assessment of the specific thrombogenic burden of an AMI is an additive tool to screen medical patients at high risk. This systematic review of the literature shows uncertainties towards some risk factors as bedrest or acute inflammatory response. Taking into account the methodological difficulties inherent to prospective and epidemiological studies, a meta-analysis focusing on these factors would be useful to refine prevention guidelines for venous thromboembolism in medical setting.
Le Jeune
S
S
Service de médecine interne, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France. sylvain.lejeune@univ-nantes.fr
Pistorius
M-A
MA
Planchon
B
B
Pottier
P
P
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001510:Bed Rest; D001528:Behcet Syndrome / Q000150:complications; D003422:Critical Care; D005602:France / Q000453:epidemiology; D014890:Granulomatosis with Polyangiitis / Q000150:complications; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008403:Mass Screening; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology