Prophylaxis of venous thromboembolism in medical patients.

Prophylaxis of venous thromboembolism in medical patients is an area where the potential benefits to patients are great. Venous thromboembolism is at least as common among medical as it is among surgical patients. Despite the widespread use of thromboprophylaxis in surgical patients, fatal pulmonary embolism is one of the most common causes of preventable death in the hospital. This may result from underuse of thromboprophylaxis in medical patients. The incidence of venous thromboembolism varies, but a history of previous venous thromboembolism, age 40 years and older, immobility, and specific illnesses such as stroke, myocardial infarction, heart failure, and cancer put patients at particular risk. Most early studies assessed the use of anticoagulants such as unfractionated heparin, low-molecular-weight heparin, and warfarin at reducing the incidence of venous thromboembolism in surgical patients. More recent studies and those currently being carried out are assessing the role of thromboprophylaxis in general medical patients and those with specific medical illnesses. As the evidence accumulates and guidelines are strengthened physicians will be able to tailor the use of thromboprophylaxis to the individual patient's needs.