Venous thromboembolism (VTE) risk stratification in general medical patients at an academic medical center


Hospital-acquired venous thromboembolism (VTE) is still a concern for general medical patients. Pharmacologic prophylaxis can reduce VTE incidence, but there is the potential for adverse effects. Therefore, determining which patients should receive VTE prophylaxis via risk scoring tools is essential. Limited evidence exists for the ideal venous thromboembolism risk assessment model (RAM) in hospitalized medical patients, as compared to other hospitalized patient subgroups such as surgical patients. The primary objective was to investigate the utilization and appropriateness of our institution-based VTE RAM and comparison to the Padua Prediction Score (PPS). This would allow for a gauge of provider risk assessment accuracy as well as appropriate predictive potential of the PPS or whether an alternative to the PPS should be considered. A total of 330 adult general medicine patients were included in this retrospective chart review. When compared to our institution-based VTE RAM, providers predominately stratified patients at a higher VTE risk than the institution-based VTE RAM. VTE incidence was 0.3%, which was lower than predicted. Significant discordance exists between providers’ VTE risk assessment and that predicted by RAMs. Our institution-based VTE RAM appears comparable to PPS; however, it was not being utilized by providers, resulting in potentially unnecessary use of pharmacologic prophylaxis.

  • The most appropriate venous thromboembolism risk assessment model for general medicine patients is undetermined.

  • Our providers generally assess patients as moderate or high VTE risk, despite our institution-based RAM which typically recommends a lower risk category than provider selection.

  • Because of provider risk assessment, more patients received pharmacologic VTE prophylaxis than would have been recommended by the RAM, which might correlate to the low incidence of VTE which was < 0.5%, although bleeding complications were not assessed in this study.

  • A prospective study utilizing the Padua Prediction Score (or similar RAM) in general medicine patients is warranted in order to decipher the best method of predicting VTE risk.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:381S–453S

    CAS  Article  Google Scholar 

  2. 2.

    Kessler CM, Cap AP (2009) Prevention of venous thromboembolism in hospitalized medical patients. Cancer Invest 27:17–27

    Article  Google Scholar 

  3. 3.

    Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160:809–815

    CAS  Article  Google Scholar 

  4. 4.

    National Institute for Health and Clinical Excellence (2010) Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. NICE clinical guideline no. 92. Royal College of Physicians, London, pp 1–519

    Google Scholar 

  5. 5.

    Rosenberg D, Eichorn A, Alarcon M, McCullagh L, McGinn T, Spyropoulos AC (2014) External validation of the risk assessment model of the international medical prevention registry on venous thromboembolism (IMPROVE) for medical patients in a tertiary health system. J Am Heart Assoc 3:1–7

    Article  Google Scholar 

  6. 6.

    Francis CW (2007) Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med 356:1438–1444

    CAS  Article  Google Scholar 

  7. 7.

    Geerts WH, Pineo GF, Heit JA et al (2004) Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:338S–400S

    CAS  Article  Google Scholar 

  8. 8.

    Deitelzweig SB, Sasahara A, Michota F, McKean SC, Jacobson A (2009) Guidelines-based use of thromboprophylaxis. J Hosp Med 4:S8–S15

    Article  Google Scholar 

  9. 9.

    Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA (2007) Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 146:278–288

    Article  Google Scholar 

  10. 10.

    Bhalla R, Berger MA, Reissman SH et al (2013) Improving hospital venous thromboembolism prophylaxis with electronic decision support. J Hosp Med 8:115–120

    Article  Google Scholar 

  11. 11.

    Rothberg MB, Lindenauer PK, Lahti M, Pekow PS, Selker HP (2011) Risk factor model to predict venous thromboembolism in hospitalized medical patients. J Hosp Med 6:202–209

    Article  Google Scholar 

  12. 12.

    Spyropoulos AC, Anderson FA Jr, Fitzgerald G et al (2011) Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest 140:706–714

    Article  Google Scholar 

  13. 13.

    Barbar S, Noventa F, Rossetto V et al (2010) A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8:2450–2457

    CAS  Article  Google Scholar 

  14. 14.

    Cohen AT, Tapson VF, Bergmann JF et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394

    Article  Google Scholar 

  15. 15.

    Kahn SR, Panju A, Geerts W et al (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155

    CAS  Article  Google Scholar 

  16. 16.

    Pai M, Lloyd NS, Cheng J et al (2013) Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial. Implement Sci 8:1–11

    Article  Google Scholar 

  17. 17.

    Tapson VF, Decousus H, Pini M et al (2007) Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the international medical prevention registry on venous thromboembolism. Chest 132:936–945

    Article  Google Scholar 

  18. 18.

    Kahn SR, Lim W, Dunn AS et al (2012) Prevention of VTE in nonsurgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e195S–226S

    CAS  Article  Google Scholar 

  19. 19.

    Vardi M, Ghanem-Zoubi NO, Zidan R, Yurin V, Bitterman H (2012) Venous thromboembolism and the utility of the Padua Prediction Score in patients with sepsis admitted to internal medicine departments. J Thromb Haemost 11:467–473

    Article  Google Scholar 

  20. 20.

    Schünemann HJ, Cushman M, Burnett M et al (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2(22):3198–3225

    Article  Google Scholar 

  21. 21.

    Maynard GA, Morris TA, Jenkins IH et al (2010) Optimizing prevention of hospital-acquired venous thromboembolism (VTE): prospective validation of a VTE risk assessment model. J Hosp Med 5:10–18

    PubMed  Google Scholar 

  22. 22.

    Kucher N, Koo S, Quiroz R et al (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352:969–977

    CAS  Article  Google Scholar 

  23. 23.

    Streiff MB, Carolan HT, Hobson DB et al (2012) Lessons from the Johns Hopkins multi-disciplinary venous thromboembolism (VTE) prevention collaborative. BMJ 344:e3935

    Article  Google Scholar 

  24. 24.

    Flanders SA, Greene T, Grant P et al (2014) Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med 174:1577–1584

    Article  Google Scholar 

  25. 25.

    Kakkar AK, Cimminiello C, Goldhaber SZ, Parakh R, Wang C, Bergmann JF (2011) Low-molecular-weight heparin and mortality in acutely ill medical patients. N Engl J Med 365:2463–2472

    CAS  Article  Google Scholar 

  26. 26.

    Blondon M, Righini M, Nendaz M et al (2019) External validation of the simplified Geneva risk assessment model for hospital-associated venous thromboembolism in the Padua cohort. J Thromb Haemost 18(3):676–680

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Megan Kunka Fritz.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fritz, M.K., Kincaid, S.E., Sargent, C.G. et al. Venous thromboembolism (VTE) risk stratification in general medical patients at an academic medical center. J Thromb Thrombolysis 51, 67–73 (2021).

Download citation


  • Venous thromboembolism
  • Classification
  • Risk factors
  • Low molecular weight heparin
  • Heparin