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Prevention of Deep Vein Thrombosis and Pulmonary Embolism in High-Risk Medical Patients. Venous thromboembolism accounts for significant morbidity and mortality in patients with acute medical illnesses requiring hospital admission. American College of Chest Physicians guidelines recommend prophylaxis with heparins as first line and mechanical methods as second line. The risk of major bleeding with anticoagulants is less than 1% and not significantly different between agents. Although data support the use of all heparins, there is a trend toward superiority of low-molecular-weight heparins (LMWHs). Because acute illness and immobility do not end at hospital discharge, extended-duration therapy with LMWHs and direct oral anticoagulants remains under investigation.