[Prevention of venous thromboembolism in medical patients]

Thromboembolism, which frequently associates deep venous thrombosis and pulmonary embolism, is a serious and potentially fatal condition that often complicates the outcome of patients hospitalized in the medical area. This disease is multifactorial and chronic, due to the risks of recurrence, and can cause severe complications (death, pulmonary hypertension, residual postphlebitic syndrome). Randomized, controlled clinical trials (Medenox, Prevent, Artemis) demonstrated the unquestionable preventive benefits of low-molecular-weight heparins and fondaparinux from hospitalization on, in a specific group of "medical" patients at minimum risk of bleeding. These findings support the systematic use of medical thromboprophylaxis in patients meeting the study criteria, as per the ACCP 2008 guidelines. However, only 50% of the patients in which thromboprophylaxis is indicated receive a treatment. This under-use can be explained by with the wide variety of patients, as well as the difficulty to assess thromboembolic risks. Overall risk assessment models, simple and clinically relevant, were developed to facilitate the decision to initiate an appropriate thromboprophylaxis in patients hospitalized in medical area.