In a subgroup of hospitalized patients with an elevated d -dimer level, there was no significant benefit for oral betrixaban over subcutaneous enoxaparin on venous thromboembolic events. However, in an exploratory analysis involving all the patients, a benefit was seen with betrixaban. Patients who are hospitalized for acute medical illnesses such as pneumonia, stroke, and heart failure are at increased risk for venous thromboembolism. 1 Prolonged immobilization and risk factors such as an elevated d-dimer level, an age of 75 years or older, cancer, or a history of venous thromboembolism increase this risk. 2 – 5 Randomized, controlled trials of parenteral anticoagulants versus placebo in such hospitalized medical patients have shown a reduction of more than 50% in the rate of venous thromboembolism, including fatal pulmonary embolism, without an increase in major bleeding. 6 – 10 Guidelines recommend the use of low-dose parenteral anticoagulants among patients at . . .