Applying risk assessment models in non-surgical patients: overview of our clinical experience

Many venous thromboembolic events occur in non-surgical patients. Prophylaxis is recommended in consensus statements but is not uniformly applied in clinical practice. Medical conditions such as stroke, cancer, and myocardial infarction are associated with thromboembolism. Patients' overall risk is affected by pharmacotherapies (e.g., cancer chemotherapy), mechanical interventions (e.g., central venous catheterization), and by intrinsic patient factors such as age, obesity and coagulation disorders, both inherited and acquired. Few large clinical trials in well-defined medical patient subgroups have been performed. Due to the perceived lower incidence of thromboembolism in non-surgical patients compared to patients undergoing high-risk surgery (e.g., hip replacement), the value of thromboprophylaxis in medical patients has been questioned. Prophylaxis may have a significant impact on the frequency of non-fatal thromboembolic events, thereby reducing short- and long-term morbidity. Due to the complexity of overall thromboembolic risk assessment in medical patients and the paucity of convincing studies at present, prospectively validated evidence-based risk assessment models for determining thrombosis risk would be useful. Further clinical research is needed to help develop accurate methods of risk stratification and to clarify the benefits of thromboprophylaxis in medical patients.