How I Treat: The approach to 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 across the world and have discussed this where indicated. Hospital-associated venous thromboembolism (VTE) or thrombosis (HAT), is the term to cover VTE occurring during admission and for 90 days post discharge and is a common patient safety problem. HATs are the most common cause of VTE accounting for 55-60% 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 the elderly, are using 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.