1. Hospital DVTs 
-Incidence 10-80%
-60% of DVT occur in hospitalized, recently d/c or nursing home patients
-PE most common preventable cause of hospital death
-5-10% in hosp deaths are 2/2 PE
-shown to reduce risk of DVT and risk of death in surgical patients
-not conclusively shown to reduce risk of death in medical patients
2. Risk factors for DVT
-Stasis - anything that causes immobility, either physical (paraplegia, stroke, leg pain, sedation) or medical (end stage heart/lung failure)
-Vessel injury - previous DVT, surgery, trauma, lines.
-Hypercoagulability - active cancer within last 6 mos, pregnancy,
3. Prevention of DVT 
-Early ambulation
-Heparin SubQ 5000 U TID - no adjustment for ESRD
-Lovenox 40, Lovenox 30 if CrCl < 30, CI in ESRD
-Fonda (factor Xa) 2.5mg
-Iffy evidence on whether SCDs really work.
4. Risk assessment tools. 
-IMPROVE trial: N>15,000, probabilty of symptomatic DVT within 90 days of d/c. Model (previous DVT, thrombophlilia, current cancer, age > 60)
-Padua N>1000
5. Bleeding risk 
-Absolute risk increase in bleeding overall for all patients is 0.5%.
-ACP 2011 guidelines lit review of last 60 years, found overall heparin prophylaxis will decrease PE events in 4/1000, but increases bleeding events in 9/1000 patients.
-IMPROVE trial model: strongest predictors of  active ulcer, bleeding within 3 mos prior to hopsitazliation, platelets < 50,000 age > 85
6. HIT occurs in up to 5% of people who get heparin.
7. Stress ulcers
-Cushings: CNS injury, usually devastating neurological event, single deep lesion in duodenum or stomach.
-Curlings: burn patients, esophagus, stomach small intestine, colon.
-Mortality can be up to 50% in ICU patients.
8. Which ICU patients needs stress ulcer prophylaxis? ASHP guidelines:
All ICU patients with a major risk factor:
-Intubation/mech vent > 48 hours
-Hx of GI ulcer/bleed within last year
-Platelets <50K, INR > 1.5
Or two minor risk factors:
-Steroids
-traumatic brain, spine, burn injury
-Sepsis
-ICU admission > 1 week
-Occult GI bleed > 6 days
-Routine stress ulcer prophylaxis is not recommended for non-ICU medical patients.
9. Which drugs
-famotidine 20
-nexium 40mg PO
-antacids and sucrafate also used
10. Problems with PPIs/etc. 
-drug interactions!
-increased risk of nosocomial infections like PNA with aspiration
-increase risk of C. diff