VTE: Risk Assessment and Prophylaxis

Question 1

VTE Prophylaxis options

Answer 1

UFH
LMWH
Factor Xa inhibitors
Vitamin K antagonists

Question 1

VTE Prophylaxis

Answer 1

Without Prophylaxis: VTE incidences 5-15% in medical patients
With Prophylaxis: VTE incidence 40-80% in surgical patients

Question 2

Risk Stratification

Answer 2

Low risk: VTE risk < 10%
minor surgery
fully ambulatory medical patients
no specific pharmacologic therapy recommended
early and aggressive ambulation

Question 3

Moderate risk: 10-40%

Answer 3

Most non-orthopedic surgery patients

Acute ill medical patients (limited mobility)

Question 4

High risk: 40-80%

Answer 4

Major orthopedic surgery

Major trauma

Spinal cord injury

Question 5

Moderate VTE risk

Answer 5

General surgery patients
- UFH, LMWH, and Factor Xa inhibitors (fondaparinux) all recommended
- continue prophylaxis up to 28 days after hospital discharge

Acute ill medical patients
- UFH, LMWH, fondaparinux, rivaroxaban
- UFH, LMWH, and fondaparinux: no specific recommendations for post-discharge VTE prophylaxis duration
- Rivaroxaban: 31-39 days total treatment

Question 6

High VTE risk

Answer 6

Orthopedic surgery (TKA or THA)
- LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (hip), UFH, or vitamin K antagonists
- continue > or equal to 10-14 days post op

Question 7

HIGH BLEEDING RISK

Answer 7

Mechanical prophylaxis preferred

intermittent pneumatic compression devices

venous foot pumps

graduated compression stockings