Venous thromboembolism prophylaxis in medical patients: Future perspectives

Venous thromboembolism is a common potentially life-threatening complication in acutely ill medical patients. Actually, over 70% fatal episodes of pulmonary embolism during hospitalization occur in non-surgical patients. In the absence of thromboprophylaxis, the incidence of venographically detected deep vein thrombosis is about 15% in medical patients and several trials and meta-analyses have clearly demonstrated the prophylactic role of unfractioned heparin and low-molecular-weight heparins. Although over the last years the knowledge of epidemiology, clinical features and prophylaxis in medical patients has significantly improved, there are still several relevant issues to investigate thoroughly. Scarce data are available on a simple way to stratify patients in order to identify those who should undergo prophylaxis and several studies clearly show that thromboprophylaxis in medical conditions is underused. Moreover, in comparison to surgical settings, very few randomized clinical trials on the efficacy of pharmacologic prophylaxis have been performed and no data at all have been published concerning mechanical prophylaxis in medical conditions. According to previous studies and results of very recently published trials, new data are available to tailor low molecular weight heparin optimal dose, whereas the optimal duration of prophylaxis in medical patients is still a matter of debate. Moreover, the possible role of the new antithrombotic drugs in the venous thromboembolism prevention in medical conditions and the optimal management of thromboprophylaxis in patients with ischaemic stroke have not been fully investigated. Although new evidence represents a significant improvement both in stratification of VTE risk and in decisions about the appropriate type and duration of prophylactic strategies in medical patients, additional data are still needed.