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Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults

Menaka Pai, MD, FRCPC
James D Douketis, MD, FRCPC, FACP, FCCP
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD


It is estimated that over half of hospitalized medical patients are at risk for venous thromboembolism (VTE, ie, deep vein thrombosis [DVT] and/or pulmonary embolus [PE]) [1]. In addition, it is widely believed that PE is the most common preventable cause of hospital death [2-8].

This topic review discusses the prevention of VTE in patients hospitalized for acute medical illnesses [9]. Approaches to the prevention of VTE in surgical patients and patients with cancer and stroke, as well as in pregnancy are presented separately. (See "Prevention of venous thromboembolic disease in surgical patients" and "Medical complications of stroke", section on 'VTE prophylaxis' and "Risk and prevention of venous thromboembolism in adults with cancer" and "Deep vein thrombosis and pulmonary embolism in pregnancy: Prevention".)


While many epidemiologic studies report venous thromboembolism (VTE) rates, in the absence of prophylaxis, that range from 10 to 80 percent, these rates are likely overestimated [2,3,5,10-26].

Accurate estimates of the incidence of clinically meaningful venous thromboembolic disease (ie, pulmonary embolus [PE] and deep vein thrombosis [DVT]) in hospitalized medical patients have been hampered by factors including the derivation of data from mixed surgical and medical populations, the reporting of both symptomatic and asymptomatic events, the increasing use of thromboprophylaxis and early ambulation during hospital admission, and the trend toward reducing length of hospital stay.

Thromboprophylaxis has been shown to reduce the risk of VTE in hospitalized medical and surgical patients. While thromboprophylaxis has been reported to reduce the risk of death in surgical patients [27,28], most studies and a meta-analysis have not been able to show a consistent beneficial effect of thromboprophylaxis on mortality in hospitalized medical patients [29-37]. The reasons for this difference between medical and surgical patients are unclear but may be related to a greater number of comorbidities in medical patients that contribute to overall deaths. In addition, clinicians should be aware that VTE prophylaxis does not eliminate the risk of VTE or VTE-related death in hospitalized patients.  

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Literature review current through: Nov 2017. | This topic last updated: Dec 08, 2017.
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