Figure 1.

Out-of-Hospital VTE Prophylaxis

It has been challenging to convince U.S. health care providers to “buy in” to the concept of extended-duration venous thromboembolism (VTE) prophylaxis after hospitalization for medical illnesses. Multiple factors have favored inertia over proactive champions of out-of-hospital pharmacologic venous thromboembolism prophylaxis. The struggle for implementation appears to be uphill. In Homer’s Odyssey, Sisyphus was punished in Hades by having to repeatedly roll a huge boulder up a hill (clinical trials leading to approval of betrixaban and rivaroxaban by the U.S. Food and Drug Administration [FDA]), only to have it roll down again as soon as he had brought it to the summit (inertia prevails). ASH = American Society of Hematology; COVID-19 = coronavirus disease-2019; EMA = European Medicines Agency; MACE = major adverse cardiac event.