Matching risk with treatment strategies in deep vein thrombosis management

Successful and cost-effective prophylaxis against venous thromboembolism (V TE) depends on the availability of safe and effective antithrombotic method s, and the ability to match these to patients according to their level of t hromboembolic risk. The last 20 years have seen significant developments in methods of thromboprophylaxis but, despite use of the best available metho ds, VTE still occurs in a significant proportion of patients. Efforts are n ow focused both on developing more effective pharmacological and physical m ethods, and improving assessment of thromboembolic risk in clinical practic e, with the goal of avoiding unnecessary prophylaxis in low-risk patients a nd providing enhanced protection to high-risk patients. Factors known to ex ert a direct effect on thromboembolic risk include previous VTE, advancing age, surgery, malignancy, immobility, and the presence of thrombophilic sta tes. Other less well-defined risk factors include obesity, pregnancy and le g varicosities. Various risk assessment models (RAMs) have been devised bas ed on these factors, but most of the resulting risk assessment formulae, so me of them based on laboratory test results, have been too complicated to g ain acceptance in routine clinical practice. Reflecting the need to refine the use of thromboprophylaxis in clinical practice, a number of RAMs have b een developed recently, based on epidemiological evidence. Some models incl ude specific recommendations for prophylaxis, based on evidence from random ized, controlled trials, (C) Lippincott Williams & Wilkins.