Medically and Critically Ill VTE Prophylaxis

Question 1

UFH for VTE Prophylaxis in Medically/Critically Ill Patients

Answer 1

5000 units SC q8hr - preferred; indicated in acute spinal cord injury
5000 units SC q12hr -considered in individuals of advanced age and low weight (i.e., total body weight less than 50 kg) or with elevated baseline activated partial thromboplastin time
No recommendation for trauma

Question 2

Enoxaparin VTE Prophylaxis in Critically/Medically Ill Patients

Answer 2

40 mg SC q24hr - general medical/critical care
30 mg SC q12hr - trauma, acute spinal cord injury, burns
30 mg q24hr - considered in individuals of advanced age and low weight (i.e., total body weight less than 50 kg) or with elevated baseline activated partial thromboplastin time

Question 3

Dalteparin VTE Prophylaxis in Medically/Critically Ill Patients

Answer 3

5000 IU SC q24hr

Question 4

Fondaparinux VTE Prophylaxis in Medically/Critically Ill Patients

Answer 4

2.5 mg SC q24hr for medically ill or suspected HIT in critical care
No recommendation in trauma, acute spinal cord injury burns

Question 5

Rivaroxaban VTE Prophylaxis in Medically Ill Patients

Answer 5

10 mg orally q24hr
extended VTE prophylaxis (31-39 days) in medically ill patients with moderate to severe restricted mobility, and at least one of the following additional risk factors: Age 75 years old or older, prolonged immobilization, history of cancer, history of VTE, history of heart failure, thrombophilia, acute infectious disease contributing to hospitalization, or a BMI greater than 35 kg/m2

Question 6

General medically ill patients Duration of VTE Prophylaxis

Answer 6

6–14 days or as long as immobile during acute illness

Question 7

Trauma VTE Prophylaxis initiation

Answer 7

can safely be started within 24–36 hours. Pharmacologic prophylaxis for patients with acute spinal cord injury may need to be delayed for 48–72 hours

Question 8

Critical care patients Duration of VTE Prophylaxis

Answer 8

For the duration of the intensive care unit stay with reevaluation when the patient is transferred to the general medical ward

Question 9

Major trauma Duration of VTE Prophylaxis

Answer 9

Until hospital discharge and continued prophylaxis in patients with impaired mobility who undergo inpatient rehabilitation (up to 8 wk)

Question 10

spinal cord injury Duration of VTE Prophylaxis

Answer 10

Until hospital discharge in patients with incomplete injuries
For 8 wk in patients with uncomplicated complete motor injury
For 12 wk or until discharge from rehabilitation in patients with complete motor injury and other risk factors

Question 11

VTE Prophylaxis in Pregnancy

Answer 11

Although warfarin could be used during the second trimester, it is typically avoided throughout
A LMWH or UFH can be used throughout pregnancy
Avoid DOACs

Question 12

Heparin dose adjust in obesity

Answer 12

BMI >40, wt > 120
Ufh 7500 units q8h
Enoxaparin 40 mg q12h