title: Thromboprophylaxis in acutely ill medical patients: results of a survey among Italian physicians.
abstract: OBJECTIVE
  acutely ill medical patients are at increased risk of venous thromboembolism (VTE) and often require thromboprophylaxis, but patient selection and adequate therapeutic decisions may be difficult due to the heterogeneity and the complexity of this population. We conducted a survey among a large cohort of Italian physicians to assess their approach to some important "grey" areas of VTE prevention in this setting.
  
  
  METHODS
  a questionnaire was distributed during the meeting of a national society of Internal Medicine (FADOI), held in May 2013. Four clinical scenarios describing areas of clinical uncertainty were administered to participants: the first on a patient with acute ischemic stroke; the second on a patient with severe renal insufficiency; the third on the duration of prophylaxis in the post-acute setting; and the last on a patient at high risk of VTE and at moderate risk of bleeding with preserved mobility.
  
  
  RESULTS
  453 questionnaires were returned (participants mean age 48.5 years). About 70% of participants systematically assess VTE and bleeding risk in their clinical practice, but a minority of them use risk assessment models. Prolonged prophylaxis in the post-acute setting was voted by more than eighty percent of participants; replies to the other three clinical scenarios were more heterogeneous with none of the options selected by more than 60% of participant.
  
  
  CONCLUSIONS
  physicians approach to "grey" areas of antithrombotic prophylaxis in the medical setting is quite heterogeneous and sometimes partially in contrast to recent guidelines, reinforcing the need for educational programs and high quality studies in this setting.
authors.affiliation: Department of Clinical Medicine Insubria University, Varese, Italy. Electronic address: fdentali@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.affiliation: Department of Clinical Medicine, ASO S. Croce e Carle, Cuneo, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Pomero
authors.affiliation: Department of Internal Medicine, Presidio Ospedaliero Unico del Levante Ligure, La Spezia, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: La Regina
authors.affiliation: Department of Internal Medicine, Presidio Ospedaliero Unico del Levante Ligure, La Spezia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Orlandini
authors.affiliation: Department of Clinical Medicine Insubria University, Varese, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Turato
authors.affiliation: Department of Internal Medicine, A.O. Ospedale Civile, Legnano, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Mazzone
authors.affiliation: Department of Internal Medicine, A.O. Careggi, Firenze, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Nozzoli
authors.affiliation: Department of Internal Medicine, Ospedale del Buon Consiglio, Napoli, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontanella
authors.affiliation: Department of Clinical Medicine Insubria University, Varese, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.affiliation: Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: Department of Internal Medicine, AOU Maggiore della Carità, Novara, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Campanini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019538:Health Care Surveys; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents
keywords: RAMs; bleeding risk; thromboprophylaxis; venous thromboembolism