Venous Thromboembolism Prophylaxis in Hospitalized Patients

Risk factors for thromboembolism include inherited conditions (such as protein C and protein S deficiencies and the factor V Leiden mutation), and acquired-risk factors (such as cancer, immobilization, presence of central venous catheters, heart failure, smoking, chronic kidney disease, and history of thromboembolism). Risk factors for bleeding with anticoagulant therapy include hypertension, cancer, prior stroke, diabetes, a bleeding disorder, and use of NSAIDs, aspirin, or antiplatelet agents. Unfortunately, these conditions exist together in many hospitalized patients, and there are no validated tools to formally assess risk and benefit of VTE prophylaxis.

Bottom Line

Assess risk for venous thromboembolism as well as bleeding risk in all hospitalized medical patients. Heparin or related agent prophylaxis does not decrease total mortality, but it does decrease the risk of PE while increasing risk of bleeding. For most people, the reduction in PE outweighs the harm of increased bleeding. When benefit outweighs risk, use subcutaneous low-dose UFH, LMWH, or fondaparinux for VTE prophylaxis. Graduated compression stockings are not recommended for VTE prophylaxis.

Dr. Olsen is a chief resident in the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.