[Prevention of deep venous thrombosis in medical patients]

Prophylaxis of deep vein thrombosis with standard heparin and low molecular weight heparin has been studied in many clinical trials in surgical patients and in few and various medical conditions in hospitalized subjects. Clinical trials have been conducted in patients with recent myocardial infarction, heart failure, stroke, pulmonary sepsis, cancer, or any acute disease with a high risk factors for deep vein thrombosis (previous thromboembolism, thrombophilia, obesity, recent bedridden, dehydratation.). The combination of a high risk disease with a high risk factor related to the history of the patient might reasonably conduct to a prophylaxis with low molecular weight heparins. The duration of this treatment has to be short and limited to the period of the acute medical condition inducing a high risk for deep vein thrombosis. Prophylaxis has to be offered to patients with ischemic stroke, cardiac failure, recent myocardial infarction, active cancer or any other acute medical disease in patients with a previous thromboembolism or thrombophilia history. Bedridden status and age are not, by themselves, an indication for prophylaxis with heparins. A widespread diffusion of these recommendations is needed to reduce overprescriptions.