Primary prevention of PE begins with prevention of DVT. Trauma, hip or pelvic surgery, general surgery, and hospi-talization or prolonged bed rest put patients at significant short-term risk. Many cases of VTE can be prevented in these patients if prophylaxis is initiated promptly. Prophylactic therapy is not effective if it is initiated after a clot has begun to form, so it is crucial to include VTE prophylaxis (subcutaneous heparin as well as mechanical interventions) on admitting orders for most patients admitted to a hospital for surgery or for serious medical conditions. Clinicians currently underutilize prophylactic therapies recommended in various clinical guidelines. They should order heparin prophylaxis on admission automatically unless there is a specific contraindication or the patient is clearly not at risk, rather than ordering prophylaxis only when risk factors are obvious (Tooher et al., 2005). Once DVT begins in the legs, prompt diagnosis and therapy can provide effective secondary prevention of the more life-threatening PE.

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