Prevention of venous thromboembolism in hospitalized medical patients

Venous thromboembolism (VTE) is a clinical disease entity which is manifested as deep venous thrombosis and/or pulmonary embolism. VTE presenting as pulmonary embolism (PE) is one of the leading causes of mortality and morbidity in the United States. Pulmonary embolism accounts for 5-10% of deaths in hospitalized patients, making VTE the most common preventable cause of in-hospital death. It appears that PE is more common in hospitalized medical patients than surgical patients, although medical patients are less likely to receive VTE prophylaxis. Up to 15% of hospitalized medical patients who do not receive thromboprophylaxis will develop symptomatic VTE. Fatal PE also seems to occur more frequently in medical rather than surgical patients. The economic burden of VTE is substantial. In 2004, the cost of a VTE occurring in hospital added over $18,000 USD to the median cost of an individual hospitalization and increased the length of stay by a median of almost 10 days. The costs associated with long-term management and chronic complications of VTE that arise after discharge from hospital are also significant. VTE prophylaxis is underused or applied incorrectly in medically ill hospitalized patients. This trend is certain to improve as external regulatory forces monitor physician practices and clinical outcomes. This review summarizes the large body of data on VTE risk factors, the efficacy and safety of pharmacologic and mechanical prophylaxis, and consensus guideline recommendations for primary in-hospital prophylaxis of medical patients.