Prevention of venous thrombosis and pulmonary embolism

The overall yearly incidence of deep venous thrombosis in the general population is approximately 0.1%. However, in hospitalised patients, this figure rises to 10-80%, depending on underlying disease and surgery performed. The main risk of attendant venous thrombosis is due to detachment of a venous thrombus subsequently leading to potentially life-threatening pulmonary embolism. Assessment of the individual risk of venous thromboembolism (VIE) is an essential factor in the planning of individual prophylactic measures. Routine measures to be adopted in every patient can be supplemented by physical or pharmacological procedures, when the risk is elevated. Apart from the classic group of heparins (unfractionated heparin, low molecular weight heparins, danaparoid) and coumarins (phenpro-coumon, warfarin), such new substances as factor-Xa inhibitors (fondaparinux, rivaroxaban) and direct thrombin inhibitors (desirudin, argatroban, dabigatran) are also available for this indication. Pulmonary embolism is a leading cause of death in hospitalised patients. In the absence of specific symptoms and a single specific diagnostic method, pulmonary embolism is often missed and thus no specific treatment is initiated. However, pulmonary embolism is a serious event: 30% of untreated patients, and up to 8% of all correctly diagnosed and properly treated patients, die of the pathophysiological consequences of pulmonary embolism. Initial risk assessment of patients with suspected pulmonary embolism is of extreme importance for the subsequent diagnostic work-up and treatment. Patients identified as being at high risk should undergo immediate computer tomography, pulmonary angiography or bedside transoesophageal echocardiography and, where indicated, receive treatment with intravenous anticoagulants and systemic thrombolysis without delay.