Prophylactic Measures Venous Thromboembolism Prophylaxis
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