Thromboprophylaxis – Key points for the angiologist

Abstract

The expertise and the advice of vascular specialists are important in diagnosis and treatment of venous thromboembolism (VTE) and equally important for thromboprophylaxis. Thus, vascular specialists are expected to have significant knowledge of the exposing and disposing risk factors for VTE. They are also expected to be familiar with the risk groups for VTE and the appropriate measures for thromboprophylaxis. Because different pharmacological prophylactic strategies are available, angiologists must be familiar with the properties, the specific labeling and the product information regarding their drugs of choice. Being familiar with the pharmacological profile and the potential risk of impaired renal function due to drug accumulation is essential for angiologists, both for the treatment and prophylaxis of VTE. Appropriate time intervals between application of thromboprophylaxis and spinal or epidural anaesthesia should be observed. This is also important for the recently available oral thrombin- and factor Xa-inhibitors. Presently available data do not support routine pharmacological prophylaxis for patients in the low VTE-risk group. Rather, individual risk benefit assessment is required in these patients. Patients with moderate or high VTE risk should receive pharmacological thromboprophylaxis. There is clear evidence and recommendation for prolonged administration of thromboprophylaxis over a 4-week period in patients following major orthopaedic surgery, such as hip replacement, hip fracture and in cancer surgery patients. Pulmonary embolism (PE) remains the most common preventable cause of death among hospitalized patients. Therefore, angiologists have a central role in ensuring adequate and consistent implementation of thromboprophylaxis, which is the number one strategy to improve patient safety in hospitals.