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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The fact that venous thromboembolism &#40;VTE&#41; is a common cardiovascular disease&#44; particularly among hospitalized patients&#44; with high mortality and morbidity&#44; makes it a major public health issue&#46; The good news is that it is the leading preventable cause of in-hospital death&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recent years have seen great improvements in all aspects of VTE&#58; prevention&#44; diagnosis and therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Aspects of VTE prevention such as identification of patients at risk and effective implementation of preventive measures probably remain the most challenging issues in this field&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">For the first time in Portugal a prospective study &#8211; the ARTE study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> &#8211; has gathered solid and valuable information regarding VTE risk profiles and the use of prophylactic measures in hospitalized patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A new risk score derived from the well-known scores of Caprini<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and Khorana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> was applied to a population of 4090 hospitalized patients in medical&#44; surgical&#44; orthopedic and oncology departments&#46; The proposed score is designed to be applied to all types of hospitalized patients&#46; This is a clear advantage over the standard scores&#44; especially considering the increasing complexity of diseases&#46; However&#44; it should be validated by prospective and independent studies before it can be used in clinical practice&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The majority of this population &#40;95&#37;&#41; were found to be at high or moderate risk for VTE&#46; Prophylaxis was used in only 67&#37; during hospital stay and in 29&#37; after discharge&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Differences in population characteristics preclude direct comparisons between studies&#44; but these findings are similar to those of the ENDORSE study&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> which found similar VTE risk profiles between countries but major asymmetries in the use of recommended prophylaxis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The small number of thrombotic events reported in the ARTE study may reflect underdiagnosis&#46; Major bleeding complications occurred in only 3&#46;9&#37; of inpatients under anticoagulant prophylaxis&#44; reflecting the safety of this approach&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">More important is the fact that the majority of VTE events occurred after hospital discharge&#44; probably as a result of inadequate prophylactic measures&#46; This finding is consistent with the need for extended VTE prophylaxis&#44; a subject now under investigation&#44; with several studies indicating a potential benefit&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Prophylaxis rules were underused in the ARTE study&#44; clearly illustrating the need for dissemination and implementation of guideline protocols&#46; There are various possible ways of improving compliance with guidelines&#44; including the use of electronic tools incorporating clinical prediction rules and risk scores&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The publication of the ARTE study in the current issue of the <span class="elsevierStyleItalic">Journal</span> is a valuable contribution to extending knowledge of this condition and has the potential to draw attention to the problem of VTE prophylaxis in Portugal&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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