Postdischarge prophylaxis for venous thromboembolism among high-risk surgery patients

The role of pharmacological prophylaxis against venous thromboembolism in high-risk surgical patients is straightforward during hospitalization but controversial after hospital discharge. Clinical trials based upon venography-detected deep vein thrombosis (DVT), yield high DVT rates which may not be clinically relevant, since most cases are asymptomatic. On the other hand, clinical surveys based upon clinically overt venous thromboembolism yield low DVT rates that underestimate the problem. If postdischarge prophylaxis is used, oral anticoagulants may be more cost-effective than low-molecular-weight heparins. However, optimal strategies for venous thromboembolism prophylaxis after hospital discharge will not be definitively provided until large studies are performed with sufficient power to detect clinically relevant endpoints such as symptomatic DVT or pulmonary embolism.