Optimal Anticoagulation Strategies for Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Comprehensive Review of Evidence-Based Practices

Background: Hospitalized patients, particularly those with reduced mobility, postoperative status, or critical illness, are at an elevated risk of developing deep vein thrombosis (DVT) and subsequent venous thromboembolism (VTE). Pharmacologic thromboprophylaxis remains a cornerstone in mitigating this risk, yet the selection of anticoagulant agents, dosing regimens, and patient-specific factors necessitate careful consideration. Objective: This review evaluates current evidence on anticoagulation strategies for DVT prevention in hospitalized patients, including pharmacologic options (unfractionated heparin, low-molecular-weight heparin, direct oral anticoagulants, and fondaparinux), risk stratification models, and special populations (renal impairment, obesity, and thrombocytopenia). Methods: A systematic literature search was conducted across PubMed, EMBASE, and Cochrane databases, focusing on randomized controlled trials (RCTs), meta-analyses, and clinical guidelines from major societies (ACCP, ASH, and ISTH). Results: Low-molecular-weight heparins (LMWHs) remain the preferred choice for most hospitalized patients due to their predictable pharmacokinetics and reduced monitoring requirements. However, direct oral anticoagulants (DOACs) are emerging as viable alternatives in select populations. Risk assessment tools such as the Padua and IMPROVE scores enhance personalized prophylaxis. Bleeding risk must be carefully weighed against thrombotic benefits, particularly in patients with comorbidities. Conclusion: Individualized anticoagulation strategies, guided by risk stratification and patient-specific factors, are essential for effective DVT prophylaxis in hospitalized patients. Future research should focus on optimizing DOAC use in acute care settings and refining protocols for high-risk subgroups.