ABSTRACT
Introduction: the burden of disease 171 Methods of prophylaxis for venous thromboembolism 172 Venous thromboembolism prophylaxis in medical
patients: clinical trials 172 Venous thromboembolism prophylaxis in nonsurgical
cancer patients 174 Venous thromboembolism prophylaxis in surgical patients 175 The timing of the first dose of antithrombotic prophylaxis 179
Venous thromboembolism prophylaxis in intensive care units 179
Venous thromboembolism prophylaxis in pregnancy 179 Venous thromboembolism prophylaxis in geriatric patients 180 Side effects of antithrombotic agents used in prophylaxis
of venous thromboembolism 180 Summary and conclusions 180 References 181
Venous thromboembolism (VTE) is one of the leading causes of death in industrial countries, killing more people than acquired immune deficiency syndrome (AIDS), breast cancer, and motor vehicle accidents combined.1,2 In the United States, coronary heart disease is responsible for almost half a million deaths each year,3 which compares with around 200 000 for pulmonary embolism (PE),4 but this latter figure may be an underestimate because of the silent nature of VTE and the declining rate of autopsy. Of the 2 million Americans who have a deep vein thrombosis (DVT) each year, 600 000 subsequently develop PE, causing fatality in around 10 percent of cases.5 Postthrombotic syndrome, a chronic, potentially disabling condition,6,7 occurs in approximately 30-60 percent of patients with DVT, and a small proportion of patients develop pulmonary hypertension. A recent study has shown that in patients with an acute episode of PE but without prior VTE, the cumulative incidence of symptomatic chronic thromboembolic pulmonary hypertension is 3.8 percent at 2 years.8 The estimated cost of care for VTE is estimated at US$1.5 billion each year.9
