Things We Do for No Reason™: Universal Venous Thromboembolism Chemoprophylaxis in Low-Risk Hospitalized Medical Patients

Clinicians should risk stratify using validated RAMs when making a patient-centered treatment plan on admission. The table outlines the most common RAMs with evidence for use in acute medically ill hospitalized patients. Although RAMs have limitations (eg, lack of prospective validation and complexity), the ACCP guidelines advocate for their use.³

Given that immobility independently increases risk for VTE, early mobilization is a simple and cost-effective way to potentially prevent VTE in low-risk patients. In addition to this potential benefit, early mobilization shortens the length of hospital stay, improves functional status and rates of delirium in hospitalized elderly patients, and hastens postoperative recovery after major surgeries.¹⁹

• Incorporate a patient-centered, risk-stratified approach to identify low-risk patients. This can be done manually or with use of RAMS embedded in the electronic health record.
• Do not prescribe chemoprophylaxis to low-risk hospitalized medical patients.
• Emphasize the importance of early mobilization in hospitalized patients.

In regard to the case, the hospitalist should use a RAM developed for the nonsurgical, non–critically ill patient to determine her need for chemoprophylaxis. Based on the clinical data presented, the three RAMs available would classify the patient as low risk for developing an in-hospital VTE. She should not receive chemoprophylaxis given the lack of data demonstrating benefit in this population. To mitigate the potential risk of bleeding, heparin-induced thrombocytopenia, and painful injections, the hospitalist should discontinue heparin. The hospitalist should advocate for early mobilization and minimize the duration of hospital stay as appropriate.

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