Background Hospitalized elderly patients are at high risk of venous thromboembolism(VTE),and the appropriate use of thrombo-prophylaxis can significantly reduce the incidence of VTE in high-risk patients.We investigated the pattern of VTE prophylaxis administra-tion among elderly medical patients and assessed its appropriateness based on the American College of Chest Physicians(ACCP)recom-mendations.Methods A cross-sectional single-center study was conducted between October 2019 and March 2020,including hospitalized(＞ 48 h),elderly(≥ 60 years),medical patients,and excluding patients receiving anticoagulant for other reason,having contraindication to thromboprophylaxis,or had VTE diagnosed within 48 h.The Padua prediction score was used to determine the patients'risk for VTE,and thromboprophylaxis use was assessed against the ACCP recommendations.Results The study included 396 patients with an average age of 75.0 ± 9.01 years,and most patients(71.7％)were classified as high risk for VTE development(Padua score ≥ 4 points).Thromboprophy-laxis use was inappropriate in 27.3％of patients,of whom 85.2％were ineligible but still received thromboprophylaxis.Patients who were classified as low risk of VTE were more likely to receive inappropriate thromboprophylaxis(AOR = 76.5,95％CI:16.1-363.2),whereas patients with acute infection or rheumatologic disorder were less likely to receive inappropriate thromboprophylaxis(AOR = 0.46,95％CI:0.22-0.96).Conclusions Although the use of thromboprophylaxis among high-risk elderly patients was reasonably adequate,a large pro-portion of low-risk patients were exposed to unnecessary risk through inappropriate overutilization of thromboprophylaxis.Thus,healthcare providers should accurately assess patients'risk before prescribing thromboprophylaxis to ensure patient safety.