Enoxaparin for the Prevention of Venous Thromboembolism
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Abstract Although the correct prophylaxis of deep venous thromboembolism in hospitalized patients is of utmost importance, and over time several authoritative guidelines have been developed, the overall degree of their implementation remains low. A major obstacle to this goal is that guidelines do not represent real patients, since their indications come from clinical trials whose population is quite different from that of clinical daily practice. Starting from the most recent literature, we suggest a risk assessment model tailored for operational realities in Italy aimed to provide an useful tool for improving the practice of venous thrombosis prophylaxis.
Clinical Practice
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Pulmonary venous thromboembolism and atherothrombosis are traditionally considered as distinct diseases. As the two entities share common risk factors and mechanisms current experimental and clinical studies support their mutual causal relationship. For the clinician, the current concept requires a different clinical, laboratory and therapeutic approach. The patient with a first arterial or venous thrombosis should be fully assessed for the risk of future clinical events, and, simultaneously addressed to aggressive preventive non-pharmacological and pharmacotherapy intervention. In this context, antiplatelet agents and statins have a potentially beneficial role.
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Risk Stratification
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The Consensus Conference statement in this issue ofThe Journal1provides a valuable review of what is known about the occurrence of deep venous thrombosis, pulmonary embolism, and their prevention. It will be interesting for all physicians and is particularly important for those in surgical disciplines. Deep venous thrombosis is common, but serious pulmonary embolism is less frequent, occurs episodically, and tends to be forgotten until a disaster occurs. The conference identified the high-risk groups and sifted through the voluminous literature on prevention. Concise, definite recommendations are given. It is clear that all high-risk groups should be given prophylaxis. The cost-benefit ratio and problems that would be associated with prophylaxis for all surgical patients were not addressed. A bibliography was gathered from a MEDLINE search of the literature from January 1984 through January 1986 as part of the consensus process. It does not list many of the classic studies
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Anticoagulant Therapy
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Most hospitalized patients have at least one risk factor for venous thromboembolism (VTE), such as pulmonary embolism or deep venous thrombosis. The American College of Physicians (ACP) has released guidelines on VTE prophylaxis in hospitalized, nonsurgical patients, including those with acute stroke.
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Tuberculosis (TB) is a common communicable disease. Active TB infection may be complicated by both venous and arterial thrombosis which are often under-recognised. We report two patients with incidental TB associated thrombosis involving different venous systems. Both responded to anticoagulant and anti-tuberculous therapy (ATT). Patients with tuberculosis are at risk of VTE and careful monitoring for venous thromboembolism (VTE) is needed during ATT. Our case illustrates the importance of having a high index of suspicion for silent VTE as it may complicate active TB infection.
Active tuberculosis
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Venous thromboembolic disease
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