Venous Thromboembolism Prophylaxis

Venous Thromboembolism Prophylaxis is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Epidemiology

Venous thromboembolism (VTE) is a preventable cause of death in hospitalized patients. In the largest observational study to date attempting to risk-stratify medical patients, 1.2% of medical patients developed VTE within 90 days of admission. A total of 10%–31% of patients were deemed to be at high risk for VTE, defined as having two or more points by weighted risk factors listed below1:

  • Three points: previous VTE, thrombophilia
  • One point: cancer, age >60 years

Prevention

  • Ambulation several times a day should be encouraged.
  • Pharmacologic prophylaxis results in a 50% decrease in VTE risk. No overall mortality benefit from prophylaxis has been demonstrated.
  • Acutely ill patients at high risk of VTE, without bleeding or high risk of bleeding, can be treated with low-dose unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) such as enoxaparin, dalteparin, or fondaparinux.1
  • Betrixaban and rivaroxaban are the only direct oral anticoagulant approved for deep venous thrombosis DVT prophylaxis in nonsurgical hospitalized patients.2
  • Aspirin alone is not sufficient for prophylaxis in hospitalized patients.3
  • At-risk patients with contraindications to anticoagulation prophylaxis may receive mechanical prophylaxis with intermittent pneumatic compression or graded compression stockings, although evidence of benefit is lacking.4

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General Principles

Epidemiology

Venous thromboembolism (VTE) is a preventable cause of death in hospitalized patients. In the largest observational study to date attempting to risk-stratify medical patients, 1.2% of medical patients developed VTE within 90 days of admission. A total of 10%–31% of patients were deemed to be at high risk for VTE, defined as having two or more points by weighted risk factors listed below1:

  • Three points: previous VTE, thrombophilia
  • One point: cancer, age >60 years

Prevention

  • Ambulation several times a day should be encouraged.
  • Pharmacologic prophylaxis results in a 50% decrease in VTE risk. No overall mortality benefit from prophylaxis has been demonstrated.
  • Acutely ill patients at high risk of VTE, without bleeding or high risk of bleeding, can be treated with low-dose unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) such as enoxaparin, dalteparin, or fondaparinux.1
  • Betrixaban and rivaroxaban are the only direct oral anticoagulant approved for deep venous thrombosis DVT prophylaxis in nonsurgical hospitalized patients.2
  • Aspirin alone is not sufficient for prophylaxis in hospitalized patients.3
  • At-risk patients with contraindications to anticoagulation prophylaxis may receive mechanical prophylaxis with intermittent pneumatic compression or graded compression stockings, although evidence of benefit is lacking.4

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