Prevention Of VTE In Nonsurgical Patients

Publication Date: February 1, 2012

Recommendations

Hospitalized Acutely Ill Medical Patients

For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis With LMWH, LDUH bid, LDUH tid, or fondaparinux. (1, B)
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For acutely ill hospitalized medical patients at low risk of thrombosis ( Table 2 ), we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis. (1, B)
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For acutely ill hospitalized medical patients who are bleeding or at high risk for bleeding, we recommend against anticoagulant thromboprophylaxis. (1, B)
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For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or at high risk for major bleeding, we suggest.
  • the optimal use of mechanical thromboprophylaxis with graduated compression stockings (GCS)
(2, C)
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  • or intermittent pneumatic compression (IPC),
(2, C)
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  • rather than no mechanical thromboprophylaxis. When bleeding risk decreases, and if VTE risk persists, we suggest that pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis.
(2, B)
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In acutely ill hospitalized medical patients who receive an initial course of thromboprophylaxis, we suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay. (2, B)
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Critically Ill Patients

In critically ill patients, we suggest against routine ultrasound screening for DVT. (2, C)
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For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis over no prophylaxis. (2, C)
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For critically ill patients who are bleeding, or are at high risk for major bleeding,
  • we suggest mechanical thromboprophylaxis with GCS
(2, C)
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  • or IPC
(2, C)
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  • until the bleeding risk decreases, rather than no mechanical thromboprophylaxis. When bleeding risk decreases, we suggest that pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis.
(2, C)
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Patients With Cancer in the Outpatient Setting

In outpatients with cancer who have no additional risk factors for VTE, we suggest
  • against routine prophylaxis with LMWH or LDUH
(2, B)
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  • and recommend against the prophylactic use of VKAs.
(, )
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In outpatients with solid tumors who have additional risk factors for VTE and who are at low risk of bleeding, we suggest prophylacticdose LMWH or LDUH over no prophylaxis. (2, B)
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In outpatients with cancer and indwelling central venous catheters, (CVCs),
  • we suggest against routine prophylaxis with LMWH or LDUH
(2, B)
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  • and suggest against the prophylactic use of VKAs.
(, )
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Chronically Immobilized Outpatients

In chronically immobilized persons residing at home or at a nursing home, we suggest against the routine use of thromboprophylaxis. (2, C)
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Long-Distance Travel

For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest frequent ambulation, calf muscle exercise or sitting in an aisle seat if feasible. (2, C)
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For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest use of properly fi tted, below-knee GCS providing 15 to 30 mm Hg of pressure at the ankle stockings during travel. (2, C)
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For all other long-distance travelers, we suggest against the use of GCS. (2, C)
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For long-distance travelers, we suggest against the use of aspirin or anticoagulants to prevent VTE. (2, C)
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Thromboprophylaxis to Prevent VTE in Asymptomatic Persons With Thrombophilia

In persons with asymptomatic thrombophilia (ie, without a previous history of VTE), we recommend against the long-term daily use of mechanical or pharmacologic thromboprophylaxis to prevent VTE. (1, C)
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Recommendation Grading

Disclaimer

Overview

Title

Prevention Of VTE In Nonsurgical Patients

Authoring Organization

Publication Month/Year

February 1, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia.

Target Patient Population

Hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Prevention

Diseases/Conditions (MeSH)

D054556 - Venous Thromboembolism, D000925 - Anticoagulants, D011315 - Preventive Medicine, D057236 - Travel Medicine, D056824 - Upper Extremity Deep Vein Thrombosis, D007103 - Immobilization

Keywords

cancer, anticoagulation, immobility, antiplatelet agents, Antithrombotic Agents, Venous Thromboembolism, travel medicine, deep venous thrombosis, thrombophilia, Anticoagulation

Supplemental Methodology Resources

Data Supplement