Speakers - 2027

Title: Venous thromboembolism: Risk stratification and preventive protocols

Abstract

Background: Venous thromboembolism (VTE) remains a major preventable cause of morbidity and mortality in hospitalized and surgical patients. It is important to establish thromboprophylactic strategies of prevention observing the balance of thrombotic and bleeding risks while accounting for the dynamic course of illness with possible changes in risk during its course.

Objective: To provide an updated approach on VTE risk stratification and prevention, highlighting individualized and dynamic assessment and emphasizing the need for risk-adapted preventive protocols.

Current Perspective: VTE risk reflects the combination of different factors related to patient, disease background and surgery patient will be submitted. Some examples of those factors are previous VTE, cancer, advanced age, obesity, immobility, acute illness, and tabagism. Validated tools such as the Caprini, Padua, and IMPROVE scores improves structured assessment, and should be understood as a complement instrument to help and not to replace clinical judgement. It is important to note that risk assessment should not be a one-time event. During hospitalization thrombotic and bleeding risks may change rapidly, and periodic reassessment and adjustment of prophylaxis could be required. The cornerstone of TVE chemoprophylaxis are low-molecular-weight heparin or unfractionated heparin, when bleeding risk is acceptable, and intermittent pneumatic compression remais as an important alternative or adjunct therapy when indicated. Some situations will demand extended prophylaxis as after major abdominal or pelvic cancer surgery in selected high-risk patients. In this setting, after an initial postoperative period, apixaban or rivaroxaban may be considered as alternatives to LMWH, although current evidence remains limited.

Conclusion: Contemporary VTE prevention should be more personal, customized and lay over a flexible mode. Optimal prophylaxis for one may be not that way for another in the same setting. A preventive protocol requires dynamic integration of thrombotic risk, bleeding risk, clinical context, and changes throughout hospitalization. Standardized institutional protocols should therefore provide a framework for consistent care while allowing individualized reassessment. The goal is unique but clinically challenging looking forward to deliver the right prophylaxis, for the right patient, at the right time, and for the appropriate duration.