Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 3-4, Pages: 249-256
https://doi.org/10.2298/SARH1404249A
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Contemporary approach to primary prophylaxis of venous thromboembolism regarding the impact of risk factors on anticoagulation therapy duration
Antonijević Nebojša M. (Faculty of Medicine, Belgrade + Clinic for Cardiology, Clinical Center of Serbia, Belgrade)
Jovanović Ljubica (Clinic for Cardiology, Clinical Center of Serbia, Belgrade)
Đorđević Valentina (Institute of Molecular Genetics and Genetic Engineering, Belgrade)
Živković Ivana (Clinic for Cardiology, Clinical Center of Serbia, Belgrade)
Vukčević Miodrag (Faculty of Medicine, Belgrade + Medical Center “Bežanijska kosa”, Belgrade)
Apostolović Milan (Faculty of Medicine, Belgrade + Institute for Orthopedic Surgery “Banjica”, Belgrade)
Kanjuh Vladimir (Faculty of Medicine, Belgrade + Committee on Cardiovascular Pathology, Serbian Academy of Sciences and Arts, Belgrade)
Adequate thromboprophylaxis primarily requires timely detection of reversible
and irreversible risk factors of venous thromboembolism (VTE) and their
categorization. It is important to note that the highest percentage of VTE
episodes occur in non-surgical (medical) patients and that VTE develops in a
large number of surgical patients upon hospital discharge; this emphasizes
the need for adequate VTE prevention in inflammatory diseases, acute medical
illness and other medical diseases as well as for prolonging and optimizing
the anticoagulant regimen after surgical intervention in the primary VTE
prophylaxis. As almost completely unrecognized and neglected major risk
factors of VTE in clinical practice, we particularly point out the chronic
obstructive pulmonary disease (COPD) and heart failure, especially in NYHA
functional class III and IV patients with significantly reduced left heart
ventricle. It is necessary to raise clinicians’ awareness of a potential
danger from wrongly and one-sidedly interpreted dyspnea and coughing signs in
patients with COPD as typical symptoms of basic respiratory disease as well
as from ascribing the signs of disease aggravation in heart failure patients
exclusively to cardial status worsening, neglecting the possibility of having
unrecognized and untreated pulmonary embolism at issue. Contemporary way of
life enhances the development of new VTE risk factors such as traveler’s
thrombosis, in particular during long-haul flights as well as in individuals
sitting at a computer for prolonged periods (e-thrombosis). Determining and
recognizing VTE risk factors, especially those formerly neglected nonsurgical
ones and simultaneous presence of multiple risk factors within a given period
is required for defining an adequate anticoagulant regimen in primary VTE
prophylaxis for surgical and non-surgical (medical) patients.
Keywords: venous thromboembolism, thromboprophylaxis, therapy duration