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Editorials |

Can We IMPROVE Bleeding Risk Assessment for Acutely Ill, Hospitalized Medical Patients?

Kok Hoon Tay, MBBS; Gregory Y. H. Lip, MD; Deirdre A. Lane, PhD; for the IMPROVE Investigators
Author and Funding Information

From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital.

Correspondence to: Deirdre Lane, PhD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Rd, Birmingham, B18 7QH, England; e-mail: deirdre.lane@swbh.nhs.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(1):10-13. doi:10.1378/chest.10-1127
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VTE encompasses DVT and pulmonary embolism (PE), and treating these conditions places a colossal burden on the US health-care system, costing > $1.5 billion per year.1 VTE is preventable; yet, it is the third most common cardiovascular disease, after heart disease and stroke,2 with one in 1,000 people in the United States experiencing VTE for the first time each year.3 VTE is potentially fatal if the first presentation is with massive PE. Medical patients who are acutely ill, immobile, and at high risk (ie, postmyocardial infarction, ischemic stroke), and those with other risk factors for development of hypercoagulation, such as active cancer, previous VTE, or severe respiratory disease, are predisposed to a greater risk of VTE4 and warrant thromboprophylaxis with low-molecular-weight heparin (LWMH), low-dose unfractionated heparin (UFH), or fondaparinux while hospitalized.5 Although there is significant evidence that such thromboprophylaxis prevents VTE,5 it is still underused because of concerns among physicians about bleeding from anticoagulants, heparin-induced thrombocytopenia, and the perception that the occurrence of overt VTE is rare because of the often-silent manifestation of VTE.4 A meta-analysis of randomized trials estimated that the risk of DVT in hospitalized medical patients receiving no thromboprophylaxis can be as high as 20%,6 and this excludes patients with acute myocardial infarction and ischemic stroke.

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