Prevención de la enfermedad tromboembólica venosa en medicina interna

Most hospitalized patients have one or more risk factors to develop venous thromboembolic disease (VTD), an important cause of inhospital morbidity and mortality. Therefore, thromboprophylaxis must be indicated in all patients with risk factors. Low molecular weight heparins are the main drugs for pharmacological thromboprophylaxis. Possibility of VTD in hospitalized non-surgical patients is estimated by the level of risk associated (low, moderate, high and very high). In this section, some important recommendations are made for the prevention of VTD in hospitalized patients with non-surgical diseases. Antiphospholipid antibody syndrome is associated with both, venous and arterial thrombosis and adverse obstetric history. The relative risk of thrombosis is between 2 and 4 and the recurrence rises up to 18.7%/ year. Pregnancy and puerperium are thrombophilic states because they elevate the plasma concentration of hemostatic factors and the platelet count and diminish antithrombin and protein S plasma levels. Thromboprophylaxis is recommended in case of antecedent or current presence of VTD. Since estrogens raise the possibility of VTD each patient must be evaluated in terms of her thrombotic risk before starting this kind of therapy. Cancer patients represent 15 to 20% of total cases of VTD. Ten per cent of patients with idiopathic deep vein thrombosis (DVT) develop cancer in the following 12 to 24 months. Cancer represents a special thrombophilia associated to very specific prothrombotic risk factors. In intensive care units DVT reaches an 80% incidence because these patients have accumulative risk factors for VTD. Some general recommendations are done for different types of patients in these units. Patients with neurological diseases are also candidates for thromboprophylaxis. We suggest some thromboprophylactic strategies for the most common entities such as stroke and cerebral hemorrhage as well as for cerebral vein thrombosis.