ArticleJournal of thrombosis and haemostasis : JTH2026
What constitutes high risk for venous thromboembolism? Determining an appropriate threshold to initiate prophylaxis.
Article in Journal of thrombosis and haemostasis : JTH, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Should we focus on sustainable thromboprophylaxis and avoid overuse of low-molecular-weight heparins?Research and practice in thrombosis and haemostasis · 2026Article
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Abstract
backgroundGuidelines recommend pharmacological venous thromboembolism (VTE) prophylaxis only for high-risk patients, but the probability of VTE that is considered "high risk" is not specified.
objectivesWe compared cost-effectiveness analysis (CEA) with alternative approaches to define an appropriate probability threshold for initiating prophylaxis in medical inpatients.
methodsOur analytic sample included 47 889 adults admitted to 10 Cleveland Clinic hospitals from October 2017 to January 2020, as well as 214 hospitalists and internal medicine residents who were surveyed from June to November 2023. We compared decision analysis with 4 alternative approaches to determine a probability threshold: the Youden Index, deriving a probability from a widely used point-based model, asking physicians' opinions, and observing physician behavior. To assess each unique approach's threshold, we applied the Cleveland Clinic VTE Model to calculate the percentage of patients whose predicted risk exceeded that threshold, and we modeled hypothetical adverse events (VTE plus major bleeding) if that threshold were used to guide prescribing.
resultsMost thresholds ranged from 0.9% to 1.5%, inversely corresponding to 19% to 35% of patients being high risk. The CEA threshold of 1% would result in 15.9 adverse events per 1000 individuals. The lowest threshold, 0.3%, produced the fewest adverse events but was highly inefficient. Compared with CEA, the 0.3% threshold required treating more than 1000 patients to prevent 1 adverse event, and quadrupled the prophylaxis rate (100% vs 24.9%).
conclusionTo improve the efficiency of prophylaxis and standardize care, guidelines should explicitly quantify the high risk of VTE using a standardized probability threshold range.
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