Venous thromboembolic disease management of the nonsurgical moderate- and high-risk patient.

Venous thromboembolism (VTE) is at least as common among medical as in surgical patients, and fatal pulmonary embolism (PE) occurs most commonly in medical patients. As in surgical patients, risk factors and high- and low-risk groups have been identified, but no useful risk assessment models (RAMs) have yet been developed for medical patients. The incidence of VTE varies widely, but a history of previous VTE, age greater than 40 years, obesity, and prolonged immobilization are all associated with an increase In risk. Stroke, spinal cord injury, and cancer patients are at particular risk of VTE. Low-dose unfractionated heparin (UFH), low-molecular-weight heparins (LMWHs), antiplatelet agents, and warfarin reduce the incidence of VTE. Current standards of thromboprophylaxis vary with indication. However, utilization is frequently low, even in high-risk patients. Effective prophylaxis must be tailored to the individual patient, taking into account both the history of the patient and the disease.