Prevention of venous thrombosis in medical patients.

Prophylaxis of deep vein thrombosis with standard heparin and low molecular weight heparin has been studied in many clinical trials in surgical patien ts and in few and various medical conditions in hospitalized subjects. Clinical trials have been conducted in patients with recent myocardial infa rction, heart failure, stroke, pulmonary sepsis, cancer, or any acute disea se with a high risk factors for deep vein thrombosis (previous thromboembol ism, thrombophilia, obesity, recent bedridden, dehydratation...). The combi nation of a high risk disease with a high risk factor related to the histor y of the patient might reasonably conduct to a prophylaxis with low molecul ar weight heparins. The duration of this treatment has to be short and limi ted to the period of the acute medical condition inducing a high risk for d eep vein thrombosis. Prophylaxis has to be offered to patients with ischemi c stroke, cardiac failure, recent myocardial infarction, active cancer or a ny other acute medical disease in patients with a previous thromboembolism or thrombophilia history. Bedridden status and age are not, by themselves, an indication for prophylaxis,vith heparins. A widespread diffusion of thes e recommendations is needed to reduce overprescriptions.