Venous thromboembolism prophylaxis in the medically ill patient

General medical patients with clinical risk factors for venous thromboembolism (VTE) have received either low-dose unfractionated heparin (LDUH) twice or three times daily or once-daily low molecular weight heparin (LMWH); however, current evidence suggests that the twice-daily LDUH may not be efficacious in the acutely ill medical inpatient. LDUH three times daily may be efficacious in most medical patients; however, it is associated with an increased risk for bleeding. The preferred strategy for prevention in the medically ill population at high to very high risk for VTE is LMWH. For patients who have a high to very high risk for bleeding, nonpharmacologic strategies, such as elastic stockings or intermittent pneumatic compression devices, are recommended.