Venous thromboembolism prevention resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

VTE Prevention in Non Surgical Patients

Acutely Ill Hospitalized Patients

Shown below is the indications and choices of VTE prophylaxis among acutely ill patients. If VTE prophylaxis is recommended, it should be administered for the period of immobilization or hospital stay. Do not extend the duration of the prophylaxis after the period of immobilization or hospital stay.[1]

 
 
 
 
 
Is the acutely ill patient at high risk of thrombosis?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the patient bleeding or at high risk of bleeding?
 
No VTE prophylaxis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
Mechanical VTE prophylaxis
For the period of immobilization or hospital stay only
Graduated compression stocking
Intermittent pneumatic compression
 
Pharmacological VTE prophylaxis
For the period of immobilization or hospital stay only
LMWH
Low dose UFH, BID
Low dose UFH, TID
Fondaparinux
 
 
 
 
 
 
 
 
 
 
 
Did the bleeding or bleeding risk subsides
AND
the patient is still at increased risk of thrombosis?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
Initiate Pharmacological prophylaxis
 
Continue mechanical prophylaxis

Critically Ill Hospitalized Patients

Cancer in Outpatient

VTE Prevention in Non Orthopedic Patients

VTE Prevention in Orthopedic Patients

References

  1. Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA; et al. (2012). "Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e195S–226S. doi:10.1378/chest.11-2296. PMC 3278052. PMID 22315261.