On November 1, the American College of Physicians (ACP) published guidelines for venous thromboembolism (VTE) prophylaxis in hospitalized nonsurgical patients, including medical patients and patients with acute stroke. The guidelines emphasize that VTE prophylaxis in medical patients (including stroke patients) should be based on an accurate assessment of the patient’s risk of VTE and bleeding, and oppose the use of graduated compression stockings (GCS) for mechanical prophylaxis of VTE in medical patients (including stroke patients). The guidelines also state that it is also undesirable for clinicians to use heparin for VTE prophylaxis in all medical inpatients regardless of risk. The optimal regimen (dose and duration of therapy) for heparin prophylaxis of VTE is unclear. The ease of drug therapy, side effects, and medical costs should also be considered when choosing which heparin to use for VTE prophylaxis.