Should individual patient risk assessment guide thrombosis prophylaxis or does it suffice to prescribe prophylaxis according to broad groups?
The 2008 ACCP guidelines identify major groups at risk for thrombosis and recommend specific thromboprophylaxis for each. For example, patients undergoing major general surgery or major orthopedic surgery are at high risk.1 This approach simplifies prophylaxis, which is required for most patients. The guidelines are based on randomized controlled clinical trials in well–defined populations. Many patients are excluded for reasons including a past history of thrombosis, cancer, or multiple comorbidities. The conclusions are strong for that particular population, but may not apply to others. Many patients encountered in clinical practice do not fit the inclusion criteria, are not covered by the clinical trial conclusions, and thus need individualized thromboprophylaxis. The guidelines point out that treatment that differs from the established guidelines may be appropriate for patients who do not fit the clinical trial criteria. This emphasizes the importance of individual patient risk ass
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