Venous thromboembolism risk and its assessment in hospitalized patients

The annual incidence of symptomatic deep venous thrombosis (DVT) and venous thromboembolic (VTE) (DVT plus pulmonary embolism) in the adult population is estimated to be 50–100 and 75–150/100,000, respectively, and the incidence doubles for every 10-year increase in age. Patients admitted to hospitals, both surgical and medical, are at particularly increased risk for VTE, and the problem has been shown to continue after discharge. The risk is increased by age, obesity, malignancy, history of VTE, family history of DVT, stay in the intensive care unit, hereditary or acquired thrombophilia, and more recently, an elevated D-dimer. This risk is also affected by the nature and duration of the operation, type of anesthesia, immobility, dehydration, sepsis, varicose veins, inflammatory bowel disease, hormone replacement therapy, pregnancy, and pregnancy-related complications (stillborn infant, unplanned abortions, placental insufficiency, and growth retarded infant). Several risk assessment scoring systems are now available for clinical use. The ones most commonly used are the Rogers, Caprini, and Chao-Yang in surgical patients and the Padua, International Medical Prevention Registry on Venous Thromboembolism, and IMPROVEDD in acutely ill medical patients. The mandatory use of a risk assessment tool on admission and in high VTE risk patients at discharge as well and implementation of an evidence-based pathway for thromboprophylaxis have made the prevention of many fatal pulmonary emboli after surgery or hospitalization a reality.