Venous thromboembolism (VTE) is a potentially serious complication occurring in 1%-2% of hospitalized medical patients. Despite this low absolute risk, as many as 82% of medical patients are considered to be at increased risk of developing VTE and are eligible for medical thromboprophylaxis. In this commentary, The author will discuss the main findings of a recent paper published in Clinical Epidemiology that questions the large proportion of individuals who are eligible for medical thromboprophylaxis, and also discuss the potential implications for the prevention of VTE. The recent paper demonstrated that when a population is divided into high- and low-risk groups, the maximum absolute risk depends on the inverse of the proportion of patients that is considered to be high risk. Consequently, even an effective treatment will only result in a small reduction in the absolute risk when the high-risk group comprises the largest proportion of this population. For medical thromboprophylaxis, this implies that even patients considered to be at high-risk for developing VTE have a maximum absolute VTE risk of 2% when the overall risk is 1.6%. Therefore, even an effective preventive initiative will only result in a small risk reduction. This small potential benefit should be weighed against potential harms associated with prophylaxis, mainly bleeding events. Still, there may be a reasonable overall balance between prevention of pulmonary embolism and major bleeding, mainly because major bleeding events are rare. Nonetheless, this discussion underscores that future risk prediction models should aim to predict the benefits and harms in individual patients in order to provide optimal care for the right patients.

译文

:静脉血栓栓塞症(VTE)是潜在的严重并发症,发生在1%-2%的住院医疗患者中。尽管绝对风险较低,但仍有多达82%的医疗患者罹患VTE的风险增加,并且有资格进行医疗血栓预防。在这篇评论中,作者将讨论《临床流行病学》上发表的一篇最新论文的主要发现,该论文质疑有资格进行医学血栓预防的大部分个人,并讨论了预防VTE的潜在意义。最近的论文表明,当将人群分为高风险和低风险组时,最大绝对风险取决于被认为是高风险的患者比例的倒数。因此,当高危人群占该人群的最大比例时,即使是有效的治疗也只会导致绝对风险的少量降低。对于医学上的血栓预防,这意味着即使总风险为1.6%,即使被认为是发生VTE的高风险患者,其绝对VTE的最大绝对风险也为2%。因此,即使是有效的预防措施也只能减少很小的风险。应当权衡这种小的潜在益处,以预防相关的潜在危害,主要是出血事件。仍然,在预防肺栓塞和大出血之间可能存在合理的总体平衡,这主要是因为很少发生大出血事件。尽管如此,本讨论强调指出,未来的风险预测模型应旨在预测个别患者的利弊,以便为​​合适的患者提供最佳护理。

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