VTE Prophylaxis Flashcards
Name two low-molecular weight heparins
- Enoxaparin
2. Dalteparin
Name a low-molecular weight heparinoid
Danaparoid
*May be used for VTE prophylaxis if the patient has heparin-induced thrombocytopenia
What is the standard dose of enoxaparin?
Standard dose of enoxaparin = 40mg subcut once daily
Reduce dose to 20mg subcut daily if eGFR
What is the standard dose of dalteparin?
Standard dose of dalteparin = 2500 IU or 5000 IU subcut once daily
Why should low-molecular weight heparins (such as enoxaparin) not be used in patients with HIT?
Cross-reactivity in 90% of cases
Name three factor Xa inhibitors
- Fondaparinux
- Rivaroxaban
- Apixaban
Name a direct thrombin inhibitor
Dalteparin
What is the standard dose of heparin?
5000 IU subcut 2-3x per day
How should pts on heparin/LMWH be monitored with regards to the potential to develop HIT
Platelet count should be monitored on days 0, 3, 5 and then on alternate days if treatment is continued. If the platelet count drops 30–50% below baseline, heparin or LMWH should be withheld and an alternate anticoagulant substituted. Severe HIT usually occurs between days five to ten but may occur earlier if a patient has been exposed to heparin recently (
What is the risk of VTE in pts having elective hip arthroplasty?
Patients having elective hip arthroplasty are at high risk of VTE (40-60%). Provided there are no contraindications, pharmacological thromboprophylaxis is recommended for approximately 5 weeks following hip replacement using one of the following agents: LMWH, fondaparinux, rivaroxaban, dabigatran, or apixaban. Fondaparinux is more effective than LMWH in major orthopaedic surgery but has a higher risk of major bleeding. Rivaroxaban, dabigatran, and apixaban are relatively new orally active agents with limited post-marketing surveillance. Rivaroxaban and apixaban have been shown to be more effective than LMWH for total hip and knee replacement surgery. The effectiveness of dabigatran and LMWH is similar. Each of these agents has individual risks and benefits, and unfortunately, there are no head to head trials to help guide choices.
What form of VTE prophylaxis is preferred in pts with severe renal impairment?
Unfractionated heparin can be considered for patients with renal impairment. It is preferred over LMWH in severe renal impairment.
What is the recommended VTE prophylaxis for patients on warfarin?
For patients already on warfarin there is no need to think about other forms of pharmacological prophylaxis. It is important to monitor their INRs during the hospital stay, however, as they can become unstable during their acute illness.
