Controversies in thromboprophylaxis: a focus on nonsurgical patients

Hospital-associated venous thromboembolism (VTE) remains a major patient safety issue globally. Guidance documents recommend the use of risk-assessment models to determine risk of VTE, with thromboprophylaxis offered to those at high risk. Implementation of such guidance with a systematic approach has been demonstrated to reduce hospital-associated VTE. However, there remain areas of controversy with differing recommendations across guidelines and a lack of high-quality supporting evidence in some patient groups. In this review, we explore some of these issues using 3 case scenarios. The first case is a patient with obesity admitted to hospital for management of pneumonia in whom we explore variations in VTE risk assessment outcome, dosing of thromboprophylaxis in obesity, and the role of postdischarge thromboprophylaxis. In the second case, the approach to VTE prevention in a hospitalized patient with known cirrhosis and longstanding thrombocytopenia is discussed. The final case involves management of a patient with an acute psychiatric illness and VTE risk factors.