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BACKGROUND There is scarce information on the strategies for preventing venous thromboembolism (VTE) in patients with cancer. PATIENTS AND METHODS VTe used the Registro Informatizado de Enfermedad TromboEmblica (RIETE) database to retrospectively assess the clinical characteristics, prophylactic details, and 3-month mortality of all Spanish patients with active cancer. RESULTS Of24 382 patients enrolled as of October 2009, 4664 (19%) had active cancer, of whom 736 (16%) had recent surgery, and 909 (19%) had recent immobility for 34 days. Ofthese, 68% of the surgical (95% CI; 65-71) and 29% ofthe immobilized patients (95% CI: 26-32) had received VTE prophylaxis. The 3-month incidence rate offatal bleeding, fatal pulmonary embolism (PE), and overall death were: 0.68% (95% CI: 0.25-1.45), 1.36% (95% CI: 0.69-2.41), and 1;.7% (95% CI: 11.4-16.4), respectively, in the surgical patients. In TE patients after immobility for ⩾4 days, the incidence rates were: 3.52% (95% CI: 2.46-4.87), 5.06% (95% CI: 3.77-6.64), and 44.4% (95% CI: 41.2-47.7), respectively. inthe 3019 patients with no recent surgery or immobilization the incidence rates were; 1.32% (95% CI: 0.96 -1.78), 3.05% (2.48- 3.71), and 23.0% (95% Cl: 21.6-24.5), respectively. CONCLUSIONS In RIETE, we found a substantial underuse ofVTE prophylaxis in at-rislpatients, particularly in cancer patients with immobility 24 days. This is important because their 3-month outcome is much worse. [ABSTRACT FROM AUTHOR]