Presenting Venous Thromboembolism: Prophylactic Options for Patients at Different Risk Levels by Kahan, James P.

Venous thromboembolism (VTE) represents a frequent and serious disorder influenced by numerous factors, but no current risk assessment model has achieved practicability for individual patient profiling of VTE risk. Following a literature review, two international panels, of medical and surgical experts, respectively, provided iterative rating of odds ratios for predisposing risk factors and Likert-type ratings for exposing risk factors. These were combined into a 3-dimensional matrix (inherent predisposing risk, general predisposing risk, exposing risk) to achieve a 4-level overall risk assessment (low, moderate, high, very high). The method was validated by holistic ratings of simulated patient cases. The appropriateness of 11 different possible prophylactic therapies for patients at all levels of risk was assessed by the panel, following the RAND/UCLA Appropriateness Method. The results of the investigation have been summarized in a DecisionMatrix that may be used by individual practitioners for guidance in deciding whether or not to use prophylaxis, and if so, what prophylaxis to employ