Prevention of Venous Thromboembolic Events

Abstract

Venous thromboembolic events increase the risk of chronic morbidity as well as acute mortality. While the incidence of thrombotic disorders is low, intrinsic as well as transient patient risk factors can lead to increased risk of events. Preventive strategies can reduce these risks, but also expose patients to bleeding and other complications. Therefore, preventive strategies should balance the reduction in thrombotic risks with increased bleeding risks. This study will review factors that influence thrombotic risks, medical thromboprophylaxis strategies, and the use of IVC filters to prevent pulmonary emboli.

Keywords

deep venous thrombosis - pulmonary emboli - venous thromboembolic event - pharmacologic prophylaxis - IVC filter

Publication History

Article published online:
19 December 2025

• References

• 1 Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015; 12 (08) 464-474
• 2 Pastori D, Cormaci VM, Marucci S. et al. A comprehensive review of risk factors for venous thromboembolism: from epidemiology to pathophysiology. Int J Mol Sci 2023; 24 (04) 3169
• 3 Anderson Jr FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (23, suppl 1): I9-I16
• 4 Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost 1991; 17 (Suppl. 03) 304-312
• 5 Gould MK, Garcia DA, Wren SM. et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2, suppl): e227S-e277S
• 6 Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138 (05) 1093-1100
• 7 Klok FA, Barco S, Konstantinides SV. External validation of the VTE-BLEED score for predicting major bleeding in stable anticoagulated patients with venous thromboembolism. Thromb Haemost 2017; 117 (06) 1164-1170
• 8 Becattini C, Pace U, Pirozzi F. et al. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood 2022; 140 (08) 900-908
• 9 Turpie AG, Levine MN, Hirsh J. et al. A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med 1986; 315 (15) 925-929
• 10 Sidhu VS, Kelly TL, Pratt N. et al; CRISTAL Study Group. Effect of aspirin vs enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: the CRISTAL randomized trial. JAMA 2022; 328 (08) 719-727
• 11 Salazar CA, Basilio Flores JE, Malaga G, Malasquez GN, Bernardo R. Direct factor Xa inhibitors versus low molecular weight heparins or vitamin K antagonists for prevention of venous thromboembolism in elective primary hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev 2025; 1 (01) CD011762
• 12 Key NS, Khorana AA, Kuderer NM. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol 2023; 41 (16) 3063-3071
• 13 Emigh B, Bose A, Stephen A, Arabi J, Adams C. Perioperative venous thromboembolism prophylaxis in orthopedic trauma: a practical review. R I Med J (2013) 2025; 108 (02) 63-68
• 14 Anderson DR, Dunbar M, Murnaghan J. et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med 2018; 378 (08) 699-707
• 15 Kahn SR, Lim W, Dunn AS. et al. 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 2012; 141 (2, suppl): e195S-e226S
• 16 Vale CL, Godolphin PJ, Fisher DJ. et al; WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Anticoagulation among patients hospitalized for COVID-19: a systematic review and prospective meta-analysis. Ann Intern Med 2025; 178 (01) 59-69
• 17 Carrier M, Abou-Nassar K, Mallick R. et al; AVERT Investigators. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl J Med 2019; 380 (08) 711-719
• 18 Khorana AA, Soff GA, Kakkar AK. et al; CASSINI Investigators. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med 2019; 380 (08) 720-728
• 19 Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111 (10) 4902-4907
• 20 Bates SM, Rajasekhar A, Middeldorp S. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv 2018; 2 (22) 3317-3359
• 21 White RH, Brunson A, Romano PS, Li Z, Wun T. Outcomes after vena cava filter use in noncancer patients with acute venous thromboembolism: a population-based study. Circulation 2016; 133 (21) 2018-2029
• 22 Mismetti P, Laporte S, Pellerin O. et al; PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA 2015; 313 (16) 1627-1635
• 23 Ho KM, Rao S, Honeybul S. et al. A multicenter trial of vena cava filters in severely injured patients. N Engl J Med 2019; 381 (04) 328-337
• 24 Alshaqaq HM, Al-Sharydah AM, Alshahrani MS, Alqahtani SM, Amer M. Prophylactic inferior vena cava filters for venous thromboembolism in adults with trauma: an updated systematic review and meta-analysis. J Intensive Care Med 2023; 38 (06) 491-510
• 25 Kaufman JA, Barnes GD, Chaer RA. et al. Society of Interventional Radiology Clinical practice guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease: developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol 2020; 31 (10) 1529-1544
• 26 Ahmed O, Kim YJ, Patel MV, Luu HH, Scott B, Cohen K. Efficacy and safety of mechanical IVC filtration for preventing pulmonary embolism in high-risk orthopedic patients undergoing total hip or knee arthroplasty. J Arthroplasty 2021; 36 (07) 2586-2590
• 27 Rowland SP, Dharmarajah B, Moore HM. et al. Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg 2015; 261 (01) 35-45
• 28 Anderson DR, Morgano GP, Bennett C. et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv 2019; 3 (23) 3898-3944
• 29 Johnson MS, Spies JB, Scott KT. et al. Predicting the safety and effectiveness of inferior vena cava filters (PRESERVE): outcomes at 12 months. J Vasc Surg Venous Lymphat Disord 2023; 11 (03) 573-585.e6