Management of Venous Thromboembolism

Venous thromboembolism (VTE) is a major cause of mortality and morbidity worldwide, and intensive research over the past few decades has resulted in great progress in our understanding of the disease, its etiology, pathophysiology, and management. As VTE is often asymptomatic and may lead to fatal pulmonary embolism, primary prevention is now an accepted approach. As a result of the substantial body of clinical evidence on their efficacy and safety, pharmacological prophylaxis with low-molecular-weight heparins (LMWHs) has been extended from the original indications in orthopedic and abdominal surgery patients to encompass both medical and surgical inpatients, outpatients, and those with venous and arterial thromboembolic disease.

The risk factors for thrombosis and appropriate VTE management strategies have now been identified for most patient groups, and significant attention has recently been focused on the importance of patient risk stratification and the appropriate targeting of prophylaxis. Evidence-based consensus recommendations have been published to assist in the risk stratification of patients and to facilitate the prescribing of appropriate thromboprophylaxis.

However, some populations, such as pregnant women, cancer patients (both medical and surgical), and critically ill patients, remain at underestimated risk of thrombotic disease. The presentations summarized in the first part of these proceedings highlight the data available for these patient groups and explore how LMWHs may be used to optimize the prevention and treatment of thrombosis for them. Looking to the future, new antithrombotic agents under development, their mode of action, and potential indications are also discussed.

With so much attention given to optimizing VTE management, the adoption of best practice, based on a broad base of evidence across similar populations in different parts of the world, varies significantly. There is a need for data on actual practices, gathered through international registries, to raise awareness of the incidence of VTE in different regions and to encourage the adoption of recommended strategies. National or regional VTE registries provide unique opportunities to gather such data and are helpful in increasing awareness of the risk of VTE, thus improving patient outcomes. In the second part of these combined proceedings, up-to-date data from regional registries in the United States, Europe, and Latin America are presented. The juxtaposition of evidence-based reviews on the optimal management of VTE and presentations on how these data have affected practice in some parts of the world highlight the gaps that can exist between best and everyday practice. It is enlightening to understand how medical practice around the world differs. It is hoped that the information in these proceedings will raise awareness of the areas of unmet need in the prevention and management of VTE, and encourage international cooperation to improve understanding of the epidemiology of VTE worldwide.