Abstract

Some answers, some questions

Recent decades have seen a great deal of progress in the prevention, diagnosis and therapy of venous thromboembolism. However, our surgical brethren have done much better in the important area of prevention than have we medical types. For decades, it has been clear that peri-operative anticoagulation in a wide variety of patients undergoing surgery is of benefit in terms of avoiding post-operative venous thrombosis and its dangerous consequence - pulmonary embolism. It is not clear why similar data were slow to accumulate for medical patients who should be at similar risk. Perhaps it was because medical patients, as a heterogeneous group, do not lend themselves to the kind of crisp definition that is the case in people with fractured hips, for example. Perhaps it was because medical patients are less uniformly immobilized for a standard period of time, and perhaps it was because pulmonary embolism can be extremely difficult to diagnose in patients with substantial pre-existing lung disease, as is often the case with medical patients. In any event, routine anticoagulation therapy was not a standard of care in medical patients for at least a decade after it became routine in many surgical patients.