Clinical cornerstone
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Clinical cornerstone · Jan 2005
ReviewVenous thromboembolism prophylaxis guidelines: use by primary care physicians.
Venous thromboembolism (VTE), a prevalent, costly medical condition, is one of the most common causes of death in the United States. Although risk factors for VTE are well known, thromboembolic events cannot be predicted because patients are asymptomatic and screening methods have limitations. Anticoagulant therapy (eg, low-molecular-weight heparin, unfractionated heparin, selective factor Xa inhibitors) has proved effective for preventing thromboembolism, including deep vein thrombosis and pulmonary embolism. ⋯ Both primary and secondary prevention of VTE remain inadequate for several reasons, including lack of awareness of the American College of Chest Physicians guidelines, of the seriousness of VTE, of the benefits of prophylaxis, and of the relatively low risk of bleeding complications. To provide appropriate treatment, physicians must assess the numbers and types of risk factors for each patient, the underlying illness or surgical procedure, and the benefits and risks of possible therapies. The problem of VTE will grow as the US population ages, as surgery is performed on increasingly sick patients, and as the length of hospital stays continues to decrease.
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Clinical cornerstone · Jan 2005
ReviewVenous thromboembolism in medically ill patients: identifying risk and strategies for prevention.
Venous thromboembolism (VTE) is a condition that has multiple causes but few warning signs. Consequently, the 2 manifestations of VTE-pulmonary embolism and deep vein thrombosis-often go unpredicted. This is especially true for medical patients. ⋯ These patients are at significant risk of VTE and require prophylaxis, an objective that is supported by the recent guidelines of the American College of Chest Physicians. In addition, several lines of clinical evidence support the use of prophylaxis in this subgroup of patients. Improved systems are needed in medically ill patients to help improve outcomes and compliance for the use of VTE prophylaxis.