Venous thromboembolism prophylaxis in the medically ill patient.

All general medical patients should be assessed for clinical risk factors for VTE. The ACCP has recommended that general medical patients with clinical risk factors receive either LDUH twice or three times daily or once-daily LMWH. Current evidence suggests that twice-daily LDUH may not be efficacious enough 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 ES or IPC devices are recommended.