Applying risk assessment models in nonsurgical patients: overview of our clinical experience

Many venous thromboembolic events occur in non-surgical patients. Prophylax is is recommended in consensus statements but is not uniformly applied in c linical practice. Medical conditions such as stroke, cancer, and myocardial infarction are associated with thromboembolism. Patients' overall risk is affected by pharmacotherapies (e.g., cancer chemotherapy), mechanical inter ventions (e.g., central venous catheterization), and by intrinsic patient f actors such as age, obesity and coagulation disorders, both inherited and a cquired. Few large clinical trials in well-defined medical patient subgroup s have been performed. Due to the perceived lower incidence of thromboembol ism in non-surgical patients compared to patients undergoing high-risk surg ery (e.g., hip replacement), the value of thromboprophylaxis in medical pat ients has been questioned. Prophylaxis may have a significant impact on the frequency of non-fatal thromboembolic events, thereby reducing short- and long-term morbidity. Due to the complexity of overall thromboembolic risk a ssessment in medical patients and the paucity of convincing studies at pres ent, prospectively validated evidence-based risk assessment models for dete rmining thrombosis risk would be useful. Further clinical research is neede d to help develop accurate methods of risk stratification and to clarify th e benefits of thromboprophylaxis in medical patients. (C) Lippincott Willia ms & Wilkins.