VTE prevention in medical inpatients - Current approach and controversies

Hospitalisation with an acute medical illness represents a significant risk factor for venous thromboembolism. Identification of patients at high risk of VTE at hospital admission and provision of appropriate thromboprophylaxis is a key intervention to improve patient safety during hospitalisation. The successful implementation of a systematic approach to VTE prevention in England highlights the effectiveness of this approach. However, the optimal strategy for identification of at-risk patients enabling targeted thromboprophylaxis provisions remains uncertain and many VTE events occur despite provision of appropriate thromboprophylaxis. In this narrative review, we discuss the pros and cons of commonly utilised VTE risk assessment tools for acutely ill medical patients, the current controversies in optimal dosing and duration of thromboprophylaxis and highlight special patient populations where further research is required.