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Thrombosis prophylaxis in hospitalised medical patients: does prophylaxis in all patients make sense?
B Schuurman1, M den Heijer, A M Nijs
1University Medical Centre St. Radboud, Geert Grooteplein 8, 6500 HB, Nijmegen, The Netherlands. miba@xs4all.nl
Background:
Most studies on thrombosis prophylaxis focus on postoperative venous thrombosis. In medical wards thrombosis prophylaxis is generally restricted to patients who are immobilised. Our primary aim was to investigate the incidence of venous thrombosis in a general internal ward, to assess whether more rigorous prophylaxis would be feasible.
Methods:
We investigated the incidence of venous thrombosis in patients hospitalised from 1992 to 1996 and related our findings to literature reports.
Results:
The incidence of symptomatic venous thrombosis in internal patients during hospitalisation was 39/6332 (0.6%). Among these 39 patients, 24 had a malignancy, whereas 876 out of all 6332 patients had a known malignancy. So, the incidence in this group with cancer was 2.7% compared with 0.3% (15/5456) in the non-cancer group (relative risk for venous thrombosis due to malignancy was 10.0 (95%C.I. 5.3-18.9).
Conclusion:
The incidence of venous thrombosis during hospitalisation in a department of general internal medicine is low and does not justify prophylaxis in all internal patients. Cancer is a strong risk factor for hospital-acquired thrombosis in the medical ward. Further studies may answer the question as to whether thrombosis prophylaxis in this subgroup is feasible.