Venous Thromboembolism Prophylaxis
The Washington Manual of Medical Therapeutics helps you diagnose and treat hundreds of medical conditions. Consult clinical recommendations from a resource that has been trusted on the wards for 50+ years. Explore these free sample topics:
-- The first section of this topic is shown below --
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 below.1
- three points: previous VTE, thrombophilia
- one point: cancer, age >60
- Ambulation several times a day should be encouraged.
- Pharmacologic prophylaxis results in a 50% decrease in VTE risk, although this includes many asymptomatic calf vein thromboses that do not progress. No overall mortality benefit from prophylaxis has been demonstrated.
- Acutely ill patients at high risk of VTE, without bleeding or high risk of bleeding, should be treated with low-dose unfractionated heparin (UFH), 5000 units SC q12h or q8, or low-molecular-weight heparin (LMWH); enoxaparin, 40 mg SC daily, or dalteparin, 5000 units SC daily; or fondaparinux, 2.5 mg SC daily.
- Betrixaban is the only direct oral anticoagulant approved for DVT prophylaxis in hospitalized patients. Betrixaban reduced the composite outcome of asymptomatic and symptomatic VTE plus VTE-related deaths when compared with enoxaparin.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