Venous Thromboembolism: Risk Assessment and Prophylaxis

Question 1

What are the two highest risk factors for VTE?

Answer 1

-Medical patients (patients admitted to a hospital)
-Surgical patients

Question 2

VTE Prophylaxis options

Answer 2

-UFH
-LMWH
-Factor Xa inhibitors
-Warfarin

Question 3

What are some examples of someone who would be at a low risk of VTE?

Answer 3

-Minor surgery
-Fully ambulatory medical patients

Question 4

What is the recommended prophylactic treatment for someone at a low risk of VTE?

Answer 4

Early and aggressive ambulation

Question 5

What are some examples of someone who would be at a moderate risk of VTE?

Answer 5

-Most non-orthopedic surgery patients
-Acutely ill medical patients (limited mobility)

Question 6

What are some examples of someone who would be at a high risk of VTE?

Answer 6

-Major orthopedic surgery
-Major trauma
-Spinal cord injury

Question 7

What is the recommended prophylactic treatment for a general surgery patient at a moderate risk of VTE?

Answer 7

-UFH, LMWH, and Factor Xa inhibitors (fondaparinux) are all recommended
-Continue prophylaxis up to 28 days after hospital discharge

Question 8

What is the recommended prophylactic treatment for an acutely ill medical patient at a moderate risk of VTE?

Answer 8

-UFH, LMWH, fondaparinux, rivaroxaban, and betrixaban are all appropriate
-Rivaroxaban: 31-39 days total treatment
-Betrixaban: 35-42 days total treatment

Question 9

What is the recommended prophylactic treatment for a patient who just had an orthopedic surgery at a high risk of VTE?

Answer 9

-LMWH, fondaparinux, rivaroxaban, apixaban, dabigatran (hip), UFH, or warfarin
-Continue 10-14 days or more postop (consider up to 35 dayas)

Question 10

What is the preferred prophylactic treatment for someone with a high bleeding risk?

Answer 10

-Mechanical prophylaxis such as intermittent pneumatic compression devices
-Venous foot pumps
-Graduated compression stockings