QJM vol. 97 no. 12 © Association of Physicians 2004; all rights reserved.
Preventing venous thromboembolism in acute medical patients
From the 1Department of Medicine and 2Blood Bank, Sapir Medical Center, Meir Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Received 12 May 2004 and in revised form 6 September 2004
Background: While extensive data support the clinical benefit and cost-effectiveness of routine thromboprophylaxis in surgical patients, the use of this approach in medical patients has been controversial. However, recent data, mainly from the MEDENOX trial, support routine thromboprophylaxis in acutely ill medical patients.
Aim: To determine attitudes towards VTE prevention in such patients, in departments of internal medicine in Israel.
Design: Questionnaire-based survey.
Methods: A questionnaire regarding aspects of VTE prophylaxis was mailed to all heads of internal medicine departments in Israel (n = 90). The questionnaire also included data concerning VTE prevention measures in specific acute medical illnesses, based on the MEDENOX study population.
Results: Fifty-eight (64%) departments returned the questionnaire. Forty-seven (81%) of them considered VTE a clinical problem in their departments, but only 37 (63%) had a routine VTE prevention policy. The most frequently used modality for VTE prophylaxis was low-molecular-weight heparin. There was little agreement concerning the exact indications or risk factors in which VTE prophylaxis measures should be used, except the combination of acute medical disabling illness and previous VTE.
Discussion: The results emphasize the need for detailed guidelines and risk assessment models for VTE prevention treatments in acutely ill medical patients, as well as better education for physicians.
Address correspondence to Dr A. Elis, Department of Medicine ‘A’, Sapir Medical Center, Meir Hospital, 44281 Kfar Saba, Israel. e-mail: avishayel{at}clalit.org.il