Evaluation of the venous thromboembolic risk in medical patients

The venous thromboembolic risk seems to be demonstrated in medical patients since the incidence of symptomatic and symptomatic deep vein thrombosis (D VT) without any prophylactic methods is respectively about 50 per cent in s troke, 25 per cent in acute myocardial infarction (AMI) and 15 per cent in internal medicine. A synthesis of clinical trials performed in medical pati ents shows that prophylactic doses of heparins (unfractionated heparin or l ow molecular weight heparins) reduce the incidence of DVT by 40 to GO per c ent compared with the lack of ano antithrombotic agents but without any sig nificant effect on total;mortality. Other antithrombotic agents such as ant iplatelet agents seem to reduce the incidence of DVT by about 40 per cent a ssociated,vith a significant decrease in total mortality of stroke or AMI. But the recommendations made on the basis of these results have to be extre mely cautious since the number of medical patients included in clinical tri als is quite limited compared with the surgical area. Moreover, each of the se recommendations is not sufficiently proven. Thus more clinical trials ha ve to be carried out with a placebo control group in internal medicine and an aspirin control group for stroke and AMI.