Issues in assessing and reducing the risk for venous thromboembolism

PURPOSE: To describe issues and challenges associated with venous thromboembolism (VTE) risk assessment and the use of drug therapies for VTE prophylaxis. SUMMARY: Patients at risk for VTE are a heterogeneous group. Systems for scoring VTE risk have been developed to identify patients who warrant prophylaxis, but most risk-scoring systems are complex and have not been validated. The optimal drug therapies and dosing strategies for reducing VTE risk are not well defined for many clinical situations, despite the availability of evidence-based guidelines from authoritative sources. Patient characteristics can influence the agent selected, dosing, timing of initiation, and duration of drug therapy. Individualized approaches to prophylaxis in patients undergoing major orthopedic surgery should take into account the presence of severe renal impairment, critical illness, morbid obesity, epidural catheters, and history of heparin-induced thrombocytopenia. To provide safe, effective VTE prophylaxis, clinicians, including health-system pharmacists, should collaborate in developing management plans tailored to patients' needs. CONCLUSION: Preventing VTE is a challenge that can be addressed by gaining an understanding of the issues involved in patient assessment and prophylactic drug therapy and using a team approach to optimize patient outcomes.