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Abstract Venous thromboembolism (VTE) lead to increase the morbidity and mortality in hospitalized patients, mainly on the critically ill patients. Its management is a daily concern for doctors, several conditions promote venous thrombosis in ICU patients, these thrombi usually forms in the proximal veins and often clinically silent, becoming evidence only when a portion of the thrombus break loose and travels to became an embolus The risk factors predisposing for thrombosis involve one or more of virchow’s triad: (1) venous stasis, (2) vein wall injury and, (3) hypercoaguability of blood, the main factors are immobility (from any causes), surgery, trauma, advanced age, malignancy, pregnancy and thrombophilia (which describes a group of conditions which are inherited, the most important of these is activated protein C resistance) and associated with high incidence of recurrent VTE. Anticoagulant therapy is indicated for patients with symptomatic VTE. The benefit of anticoagulation was first demonstrated in 1960 and confirmed by randomized clinical trials. A mortality rate of less than 5 percent should be achieved with the use of intravenous heparin and oral anticoagulants; this may be further reduced with the use of low molecular weight heparin. Anticoagulation is usually achieved initially with unfractionated or low molecular weight heparin, followed by oral anticoagulation with warfarin for a minimum of three months More recently, new oral anticoagulant drugs, namely the direct thrombin inhibitor dabigatran etexilate and the direct factor Xa inhibitor rivaroxaban and apixan , have been approved for clinical use in several countries. A growing body of laboratory and clinical data is becoming available to better understand the mechanisms of action and the optimal management of these new compounds |