Venous thromboembolism prevention resident survival guide

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

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.

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

Shown below is an algorithm depicting the choices for VTE prophylaxis among critically ill patients. Note that routine ultrasound screening for DVT is not recommended among critically ill patients.

Is the critically ill patient bleeding or at risk of bleeding?

Yes

No

Mechanical VTE prophylaxis Graduated compression stocking Intermittent pneumatic compression

Pharmacological VTE prophylaxis LMWH Low dose UFH

Cancer in Outpatient

Shown below is an algorithm depicting VTE prophylaxis among cancer patients. Note that, canxer patients with indwelling central venous catheters do not require VTE prophylaxis.

Does the patient have a solid tumor AND additional risk factors for VTE?

Yes

No

Pharmacological VTE prophylaxis LMWH Low dose UFH

No VTE prophylaxis