Don’t routinely prescribe venous thromboembolism (VTE) prophylaxis to all hospitalized patients; use an evidence-based risk stratification system to determine whether a patient needs VTE prophylaxis. If the patient does warrant prophylaxis, use a bleeding risk assessment to determine whether mechanical prophylaxis is more appropriate than pharmacologic prophylaxis.

Rationale and Comments

VTE is a major cause of morbidity and mortality in hospitals. Pharmacologic prophylaxis has been shown to reduce the risk of clinically significant VTE. Although VTE prevention should be considered for every hospitalized patient, excess VTE prophylaxis—either prophylaxis inappropriately administered to patients at low risk of VTE or to high-risk patients with contraindications—can be harmful. National guidelines recommend objective risk stratification for VTE prevention in hospitalized medical patients.

Sponsoring Organizations

Society of Hospital Medicine – Adult Hospital Medicine

Sources

ACCP guidelines
ACP guidelines
ASH guidelines

Disciplines

Hematologic

References

Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in non-surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice. Chest. 2012;141(2 suppl):e195S-e226S.
Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018;2(22):3198-3225.
Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines [published correction appears in Chest. 2012;141(5):1369]. Chest. 2012;141(2 suppl):e227S-e277S.
Qaseem A, Chou R, Humphrey LL, et al.; Clinical Guidelines Committee of the American College of Physicians. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;155(9):625-632.
Stuck AK, Spirk D, Schaudt J, et al. Risk assessment models for venous thromboembolism in acutely ill medical patients. A systematic review. Thromb Haemost. 2017; 117(4):801-808.
Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-2457.