title: Venous thromboembolism prophylaxis of acutely ill hospitalized medical patients. Are we under-treating our patients?
abstract: Venous thromboembolism (VTE) is frequent in patients hospitalized in Internal Medicine wards. It carries a considerable morbidity and mortality. Recommendations for use of anticoagulation are graded 1A in leading evidence-based consensus guidelines. Implementation of these guidelines is suboptimal. Lack of awareness seems to be an important factor for the low implementation rate of thromboprophylaxis in Internal Medicine wards, but other factors may be equally important: some clinicians find the data favoring thromboprophylaxis unconvincing or believe that pharmacological prevention is too risky for the average medical inpatient. The following review will show that although there is a dispute about the clinical importance of some manifestations of thromboembolic disease, anticoagulation significantly reduces the risk for clinically relevant VTE. The bleeding risk in most patients is low and does not outweigh the benefit of treatment. Pharmacological or mechanical thromboprophylaxis is cost-effective when administered to at-risk patients. Better awareness and judicious use of risk assessment models should help the attending physician to balance the risk of VTE against the potential bleeding risk.
authors.affiliation: Coagulation unit, Hadassah medical center, Kiryat Hadassah, p.o.b 12000, Jerusalem 91120, Israel. batroth@smile.net.il
authors.forename: Batia
authors.initials: B
authors.lastname: Roth-Yelinek
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019317:Evidence-Based Medicine / Q000592:standards*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants