Purpose: The risk factors for venous thromboembolism (VTE), recommendations for risk stratification and prophylaxis of VTE based on risk, nonpharmacologic and pharmacologic interventions used for prophylaxis, and clinical controversies surrounding VTE prophylaxis are discussed.
Summary: Risk factors for VTE are common in hospitalized patients and readily identifiable in patients' medical history. The recommended prophylactic strategy depends on the degree of risk. Nonpharmacologic interventions may suffice for patients at low risk for VTE, but antithrombotic drug therapy is recommended for patients at moderate or higher risk. Newer antithrombotic agents with more specific activity on the coagulation cascade than older agents have been developed to improve on efficacy, safety, and convenience. Current recommendations of the American College of Chest Physicians (ACCP) do not reflect the availability of the newest agents; these agents are likely to be included as options for patients at the highest risk for VTE when ACCP updates its recommendations in the near future.
Conclusion: The optimal agent, timing of initiation, and duration of prophylaxis in patients at the highest risk for VTE are ongoing controversies.