Clinics in chest medicine
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Clinics in chest medicine · Dec 2010
ReviewDeep vein thrombosis prophylaxis in hospitalized medical patients: current recommendations, general rates of implementation, and initiatives for improvement.
Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is a leading cause of preventable morbidity and mortality following hospitalization. In the last decade, investigators have used randomized controlled trials to assess the efficacy and safety of various methods of VTE prevention for more than 20,000 medical patients. Identifying medical patients at risk for VTE and providing effective prophylaxis is now an important health care priority to reduce the burden of this morbid and sometimes fatal disease. ⋯ It is effective, safe, and cost effective. Multiple scientific guidelines support VTE prophylaxis in medical patients. Regulatory and accreditation agencies have mandated that hospitals use formalized systems to assess VTE risk and provide clinically appropriate prophylaxis measures to patients at risk.
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Hypercoagulable states can be inherited or acquired. Inherited hypercoagulable states can be caused by a loss of function of natural anticoagulant pathways or a gain of function in procoagulant pathways. ⋯ Venous thromboembolism occurs when the risk exceeds a critical threshold. Often a triggering factor, such as surgery, pregnancy, or estrogen therapy, is required to increase the risk above this critical threshold.