OBJECTIVES: To assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis in hospitalised acutely ill medical patients in Europe. METHODS: A systematic literature search was conducted in major databases on the epidemiology and treatment practices of VTE prevention among adult patients treated in hospital for major medical conditions. Relevant studies published between 1999 and April 2010 were captured. RESULTS: Thirty-five multinational and country-specific studies were retrieved, including randomized clinical trials, registry and chart audits, meta-analyses, and cross-sectional, retrospective, prospective, and observational studies. Among patients admitted for an acute medical illness, the incidence of VTE diagnosed during hospitalisation ranged from 3.01% (mean hospital stay: 4.5 days) to 15% (day 14 from index hospitalisation). While clinical guidelines recommend pharmacological VTE prophylaxis to all patients hospitalised for an acute medical illness who are bedridden, a clear identification of specific risk groups who would benefit from VTE prevention is lacking. In the majority of studies captured, prophylaxis was underused among medical inpatients (all diseases); 33% to 82% of all patients hospitalised for acute medical illnesses did not receive any VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in agreement with guidelines, due to short duration, suboptimal dose, or inappropriate type of prophylaxis. Of all prescriptions, low molecular weight heparin was the most widely prescribed anticoagulant. In most cases, the duration of VTE prophylaxis did not exceed hospital stay duration, and varied between 5 and 33.8 days (mean duration). CONCLUSIONS: VTE imposes a substantial burden among hospitalised medical patients. Despite the proven efficacy of prophylaxis, utilisation remains suboptimal among medical patients at risk for VTE, stressing the necessity for improved or easier access to proven preventive therapies among these patients.