How I approach the prevention and treatment of thrombotic complications in hospitalized patients

This article uses case-based discussion to review prevention and management of thrombotic problems in hospitalized patients that involve a clinical hematologist. There is variation in the clinical hematologist's role in thrombosis practice throughout the world, and we discuss this where indicated. Hospital-associated venous thromboembolism (VTE), or hospital-associated thrombosis (HAT), is the term to cover VTE occurring during admission and for 90 days postdischarge and is a common patient safety problem. HATs are the most common cause of VTE accounting for 55% to 60% of all VTE, with an estimated 10 million occurring globally. VTE risk assessment alongside evidence-based thromboprophylaxis reduces this risk significantly. Many hospitalized patients, especially older patients, use direct oral anticoagulants (DOACs), mainly to prevent stroke in atrial fibrillation. DOACs require perioperative management and may need urgent reversal. Other complex interventions such as extracorporeal membrane oxygenation which require anticoagulation are also discussed. Lastly, those with uncommon high-risk thrombophilias, especially those with antithrombin deficiency, produce unique challenges when hospitalized.

Automated summary

This article reviews the prevention and management of thrombotic problems in hospitalized patients, focusing on the role of clinical hematologists. The role of clinical hematologists in thrombosis practice varies worldwide, and this variation is discussed in the article. Hospital-associated venous thromboembolism (VTE), or hospital-associated thrombosis (HAT), is a common patient safety issue, and VTE risk can be significantly reduced through evidence-based thromboprophylaxis and risk assessment. The use of direct oral anticoagulants (DOACs) is common in hospitalized patients, especially older patients, for stroke prevention in atrial fibrillation, and their perioperative management and urgent reversal are important considerations. The article also discusses other complex interventions requiring anticoagulation and the unique challenges associated with uncommon high-risk thrombophilias during hospitalization.