Thrombosis prophylaxis in hospitalised medical patients: does prophylaxis in all patients make sense?

Background: Most studies on thrombosis prophylaxis focus on postoperative v enous thrombosis. In medical wards thrombosis prophylaxis is generally rest ricted to patients who are immobilised. Our primary aim was to investigate the incidence of venous thrombosis in a general internal ward, to assess wh ether more rigorous prophylaxis would be feasible. Methods: We investigated the incidence of venous thrombosis in patients hos pitalised from 1992 to 1996 and related our findings to literature reports. Results: The incidence of symptomatic venous thrombosis in internal patient s during hospitalisation was 39/6332 (0.6%). Among these 39 patients, 24 ha d a malignancy, whereas 876 out of all 6332 patients had a known malignancy . So, the incidence in this group with cancer was 2.7% compared with 0.3% ( 15/5456) in the non-cancer group (relative risk for venous thrombosis due t o malignancy was 10.0 (95%C.I. 5.3-18.9). Conclusion: The incidence of venous thrombosis during hospitalisation in a department of general internal medicine is low and does not justify prophyl axis in all internal patients. Cancer is a strong risk factor for hospital- acquired thrombosis in the medical ward. Further studies may answer the que stion as to whether thrombosis prophylaxis in this subgroup is feasible. (C ) 2000 Elsevier Science B.V. All rights reserved.