key: cord-0751586-llcrfp1m authors: Goldhaber, Samuel Z. title: Thromboembolism Prophylaxis for Patients Discharged From the Hospital: Easier Said Than Done date: 2020-06-30 journal: J Am Coll Cardiol DOI: 10.1016/j.jacc.2020.05.023 sha: 1e526edc9c2ce716cb407ea60537ec5034dda506 doc_id: 751586 cord_uid: llcrfp1m [Figure: see text] The theme of reduction of overall cardiovascular events, including VTE, was also observed with betrixaban. A betrixaban substudy of APEX reported a 31% reduction of the combined endpoint of myocardial infarction, stroke, and cardiovascular death compared with standard prophylaxis using enoxaparin, 40 mg daily for 6 to 14 days (7) . The findings with rivaroxaban and betrixaban suggest that we should abandon a silo approach for the prevention of venous or arterial thrombosis and promote a holistic strategy to vascular disease. bleeding exclusions is too complicated to deal with 2) 1% absolute VTE reduction is not enough to spawn "local champions" at U.S. hospitals 3) Hospital budgets strained post-COVID-19 Implementation of the lessons from APEX and MARINER will be an uphill journey (Figure 1) . The American Society of Hematology guidelines recommend against the use of extended-duration anticoagulant prophylaxis after hospital discharge (8) . Those physicians who advocate for out-of-hospital VTE prophylaxis will have to convince their col- Prevention of fatal postoperative pulmonary embolism by low dose of heparin: an international multicentre trial Prevention of venous thrombosis and pulmonary embolism Extended thromboprophylaxis with betrixaban in acutely ill medical patients Rivaroxaban for thromboprophylaxis in acutely ill medical patients Post-discharge prophylaxis with rivaroxaban reduces fatal and major thromboembolic events in medically ill patients Rivaroxaban for thromboprophylaxis after hospitalization for medical illness Reduction of cardiovascular mortality and ischemic events in acute medically ill patients American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients