Consensus Statements and Guidelines on Antithrombotic Therapy  VTE is a major health problem, particularly among the elderly. VTE  Symptoms :non-specific, first clinical presentation is often fatal PE. PE  Undetected DVT post-thrombotic syndrome and recurrent DVT.DVT  The Sixth ACCP consensus statement and guidelines : prevention and management of VTE. evidence-based reviewACCP VTE

 Despite the availability of these guidelines, thromboprophylaxis tends to be underutilized, especially in the medical setting.

 The magnitude of the problem.  Risk factors for VTE.VTE  Underutilization of thromboprophylaxis

 Public Figures Affected by PE  The former Vice-president of the USA, Dan Quayle, was diagnosed with an infection of the upper respiratory tract. After failing to respond to treatment, he was found to be suffering from multiple pulmonary emboli.

 VTE is one of the leading causes of death in the USA VTE  killing more people than AIDS, breast cancer, and road-traffic accidents combined.AIDS  Coronary heart disease 400,000  PE,200,000PE  Accidents 97,900  Highway fetalities 42,815  Breast cancer 40,200  AIDS 14,478

PHT 30,000 Death 60,000 Post thrombotic syndrome 800,000 DVT 200,000 PE 600,000 Lancet 1999;353:1386-9

Major PE diagnosed at Autopsy Patient groupPE suspensions prior to death No PE suspensions prior to death Post –op patient (n=11) 7(64%)6 (36%) Medically ill patients (n=50) 13(26%)37(74%) Total (n=61)20(33%)41( 67% ) Framingham study 3,470 patients, autopsy in 39% of 998 patients.1 Overall, 16% of these patients were found to have suffered a fatal PE.PE

Fatal PE Diagnosed at Autopsy in Medical Patients Nielsen et al;1983 Scandinavia83% Hauch et al;1990 Denmark78% Sperry et al;1990 USA59% Cohen et al;1996 UK81% Framingham study, with approximately three-quarters of fatal pulmonary emboli in medical patients being diagnosed at autopsy