Prevention of Venous Thromboembolism in the Geriatric Patient Amir K. Jaffer, MD a, T , Daniel J. Brotman, MD b a The Internal Medicine Preoperative Assessment Consultation and Treatment Center and the Anticoagulation Clinic, Section of Hospital Medicine, Department of General Internal Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A72, Cleveland, OH 44195, USA b Hospitalist Program, The Johns Hopkins Hospital, Jefferson 242, 600 North Wolfe Street, Baltimore, MD 21287, USA Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third leading cause of cardiovascular death after myocardial infarction and stroke in the United States [1]. VTE has an average annual incidence of more than 100 cases per 100,000 person-years [2]. Autopsy studies demonstrate large numbers of silent events [3,4] leading to the widely reported estimates of 2 million DVT cases and up to 200,000 PE deaths annually [5]. Because VTE disproportionately affects the elderly, and in the United States seniors are the fastest growing subset of the population, the num- ber of VTE events and VTE-associated deaths will likely continue to increase [1,6–8]. Epidemiology The rate ratio for VTE among elderly patients is about 10 to 20 times that of young adults [9], making advanced age an important risk factor for VTE. The mechanisms for the age-dependency of VTE are multiple. With aging, there is an increasing prevalence of chronic conditions that contribute to VTE risk, in- cluding malignancy, atherosclerosis, heart failure, and immobility. Compared with 0749-0690/06/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.cger.2005.09.003 geriatric.theclinics.com T Corresponding author. E-mail address: jaffera@ccf.org (A.K. Jaffer). Clin Geriatr Med 22 (2006) 93– 111