Risk assessment as a guide for the prevention of the many faces of venous thromboembolism

BACKGROUND: Approximately 900,000 cases of deep vein thrombosis and pulmonary embolism occur annually in the United States, and one-third lead to the patient's death. A variety of surgical factors contribute to Virchow's triad of venous stasis, vascular injury, and hypercoagulability, including intraoperative venous distension and microvascular endothelial damage. Patients also may have individual risk factors such as a history of thromboembolism, cancer, advanced age, or a genetic trait linked to hypercoagulation. This article discusses recent trends in the development and validation of venous thromboembolism risk scores, including the results of a large validation study. DATA SOURCES: A Medline literature search was performed to identify original studies. CONCLUSIONS: Venous thromboembolism risk scores have been developed for groups of patients based on a few broad risk categories, but a more accurate, individualized risk score can be obtained using a recently validated risk scoring system, which can be used to determine the type and length of prophylaxis to administer. Further studies are under way to refine this system. (C) 2010 Elsevier Inc. All rights reserved.