Prophylaxis for Thromboembolism in Hospitalized Medical Patients

A 62-year-old man is admitted with fever, cough, and dyspnea. He is weak, appears to be dehydrated, and has purulent sputum. His temperature is 39.2°C, respirations 22, and blood pressure 128/69 mm Hg. There are crackles over the left lower lung field, and chest radiography shows a density in the left lower lobe that is consistent with pneumonia. Should thromboprophylaxis be provided? If so, in what form? The Cl inic a l Problem Venous thromboembolism is a frequent cause of preventable illness and death in hos-pitalized patients. About 25 % of all cases of venous thromboembolism are associated with hospitalization,1,2 and 50 to 75 % of cases of venous thromboembolism in hos-pitalized patients occur in those on the medical service.3-5 In prospective studies of hospitalized patients at high risk who were not receiving prophylaxis, deep-vein throm-bosis was found by means of venography in 10.5%6 to 14.9%7 of patients and by means of ultrasonography in 5.0 % of patients.8 In these studies, pulmonary embolism oc-curred in 0.3 to 1.5 % of cases, and proximal deep-vein thrombosis in 2.0 to 4.9 % of cases. Thrombosis was asymptomatic in over 70 % of cases, probably because mos