Thromboprophylaxis Failure in the Adult Medical Inpatient

Venous thromboembolism (VTE), a leading cause of morbidity and mortality among hospitalized patients, is often due to prophylaxis failure rather than omission, but few studies have identified the risk factors for failure. Risk factors for thromboprophylaxis failure include personal or family history of VTE, use of vasopressors or inotropes, increased body mass index, cranial surgery, intensive care patient, leukocytosis, indwelling central venous catheter and admission from a long-term care facility. Identifying patients at risk for thromboprophylaxis failure should prompt close observation during hospitalization for signs of VTE, close observation after discharge and potentially more aggressive prophylaxis strategies, although no specific guidelines exist for medical patients at this time.