Scope and Target Population:
This guideline addresses risk assessment for venous thromboembolism (VTE), risk assessment for bleeding, and mechanical and pharmacologic therapies to reduce the occurrence of VTE in adult hospitalized patients.

Clinical Highlights and Recommendations:

• All patients should be evaluated for VTE risk upon hospital admission, change in level or care, change in providers, and upon discharge.
  
• All patients should receive proper education regarding VTE risk, signs and symptoms of VTE, and prophylaxis methods available.
  
• Early and frequent ambulation should be encouraged when possible in all patient groups.
  
• Risk of VTE development continues beyond hospitalization, and the need for postdischarge anticoagulation should be assessed.
  
• All medical patients who have a high risk for VTE should receive anticoagulation prophylaxis unless contraindicated.
  
• Aspirin is not recommended for routine VTE prophylaxis following hip/knee arthroplasty but may be considered in some circumstances. Further study is needed.
  
• Aspirin and antiplatelet drugs are not recommended for VTE prophylaxis in other surgical patients or medically ill patients.
  
• For all patients receiving spinal or epidural anesthesia, precautions should be taken when using anticoagulant prophylaxis to reduce the risk of epidural hematoma.

Priority Aims:

1. Increase the percentage of hospitalized adult patients (18 years and older) who are appropriately assessed for VTE risk within 24 hours of admission.
   
2. Increase the percentage of patients who are assessed for VTE risk upon change in level of care, change in providers, and/or upon discharge.
   
3. Increase the percentage of hospitalized adult patients (18 years and older) who are at risk for VTE who have received education for VTE that includes VTE risk signs and symptoms, and treatment/prophylaxis methods available within 24 hours of admission.
   
4. Increase the percentage of hospitalized adult patients who begin early and frequent ambulation to reduce VTE risk.
   
5. Increase the percentage of hospitalized adult patients (18 years and older) receiving appropriate pharmacological and/or mechanical prophylaxis treatment within 24 hours of admission.
   
6. Reduce the risk of complications from pharmacologic prophylaxis.
   
7. Increase the percentage of patients who are discharged on warfarin who have an international normalized ratio (INR) within one week.