Perspective:

This large, multicenter, hospital-based cohort study sheds important light into the practice patterns and real-world outcomes associated with pharmacologic VTE prophylaxis in hospitalized medical patients. While there is little doubt that hospitalized surgical patients are at substantial risk for VTE, there have been conflicting reports as to the risk for generalized medical patients. Prior studies demonstrating benefit of pharmacologic VTE prophylaxis have often included surgical patients, patients in the intensive care units (ICU), and patients with malignancy. Those patients are at inherently higher baseline risk of VTE than the general medicine hospitalized patient without cancer. In this study, surgical and ICU patients were excluded, but a significant percentage of the cohort had a history of malignancy. Additionally, unlike some prior studies, this analysis relied on symptomatic VTE as the primary outcome, which is likely to be more clinically relevant than VTE identified on routine imaging of all patients. This study highlights the importance of baseline risk assessment before implementation of population-wide therapeutic strategies. Based on these results, policy makers may reconsider the utility of a strategy to encourage pharmacologic VTE prophylaxis among all hospitalized patients and instead consider targeted interventions at patients with higher VTE risk, such as surgical, ICU, and cancer patients.