Medical Patients

Hospitalised patients with acute medical diseases who are expected to be immobile for 3 or more days or have reduced mobility and additional risk factors are at an increased risk of thromboembolism and should be considered for pharmacological prophylaxis [26]. In a non-surgical setting (e.g. in internal medicine, neurology) the individual risk is determined by the disease type and also the degree of immobility.

It is important to assess all patients for risk of bleeding before offering pharmacological VTE prophylaxis. Do not offer pharmacological VTE prophylaxis to patients with any of the risk factors for bleeding unless the risk of VTE outweighs the risk of bleeding [26].

Current recommendations for the use prophylaxis for VTE are based on randomised, placebo-controlled trials of short-term, low-dose pharmacological thromboprophylaxis that have demonstrated a relative risk reduction of 45–64% of VTE in acute medically ill patients. These studies used LMWH or fondaparinux: the MEDENOX trial used enoxaparin [30], the PREVENT trial used dalteparin [31], and the ARTEMIS trial used fondaparinux [32].

Based on these studies, it has been recommended that fondaparinux or LMWH are used as pharmacological prophylaxis [26]. It is recommended that prescribers consult the summary of product characteristics for the individual LMWH.

For those patients with severe renal impairment or renal failure, UFH is recommended. No new oral anticoagulants (NOACs) are licensed for the prevention of VTE in medical patients. Mechanical VTE prophylaxis is recommended in medical patients in whom pharmacological VTE prophylaxis is contraindicated.