Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.

静脉血栓栓塞症（VTE）是住院患者可预防的主要死亡原因，数据始终显示，急性病的医疗患者在出院后仍处于与VTE相关的发病率和死亡率增加的风险。在包括四分之一住院医疗病患者在内的关键患者亚组中，急性住院后开具长达45天的延长血栓预防措施，这代表了医院医师对VTE预防的思考方式的转变。使用经过验证的VTE和出血风险评估模型对急性病患者进行原发性血栓预防领域的进展已经建立了关键的患者亚组，这些亚组具有较高的VTE风险和较低的出血风险，可以受益于院内和长期的血栓预防。直接口服抗凝药贝曲沙班和利伐沙班目前已获得美国食品和药物管理局的批准，可用于医疗疾病患者的住院和长期血栓预防，并在这些关键亚组中提供净临床收益。由于过度的炎症，血小板活化，内皮功能障碍和止血，冠状病毒病-2019年可能使患者倾向于VTE。这些患者的最佳预防策略需要进一步研究。本文旨在回顾预测和预防VTE的最新概念，并讨论住院医疗患者延长血栓预防的新时代。经美国食品药品监督管理局（FDA）批准，可对内科疾病患者进行院内和长期血栓预防，并在这些关键亚组中提供净临床收益。由于过度的炎症，血小板活化，内皮功能障碍和止血，冠状病毒病-2019年可能使患者倾向于VTE。这些患者的最佳预防策略需要进一步研究。本文旨在回顾预测和预防VTE的最新概念，并讨论住院医疗患者延长血栓预防的新时代。经美国食品药品监督管理局（FDA）批准，可对内科疾病患者进行院内和长期血栓预防，并在这些关键亚组中提供净临床收益。由于过度的炎症，血小板活化，内皮功能障碍和止血，冠状病毒病-2019年可能使患者倾向于VTE。这些患者的最佳预防策略需要进一步研究。本文旨在回顾预测和预防VTE的最新概念，并讨论住院医疗患者延长血栓预防的新时代。