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DVT Prophylaxis
Dr Swapnil Pawar
VTE Prophylaxis
Written by Dr Ashly Liu
Venous thromboembolism risk
As a junior medical officer, one of your responsibilities is to ensure all your patients have been assessed with the VTE powerplan, which enables you to consider whether this patient is on the appropriate VTE prophylactic agent. There is a venous thromboembolism risk assessment tool that is linked through this PowerPlan by the Clinical Excellence Commission.
You should be balancing the risk of thrombosis, and risk for major bleeding and considering any contraindications when selecting this agent.
When assessing the risk for thrombosis, you can recall Virchow’s triad. This refers to the following:
- Intravascular endothelial injury
- E.g. surgery, infection
- Venous stasis
- E.g. immobility, hospital admission
- Hypercoagulability
- E.g. malignancy, inherited thrombophilia
Regarding bleeding risk, consider surgical risk factors and individual risk factors. Surgery with high bleeding risk refers to cardiac surgery, surgeries with major trauma, or those undergoing neurosurgical procedures where thromboprophylaxis may result in potentially catastrophic consequences. Individual risk factors for bleeding include underlying bleeding disorders and thrombocytopenia.
Non-pharmacological options for DVT
- Early ambulation
- Graduated compression stockings
- Intermittent pneumatic compression
Pharmacological prevention of DVT
| DVTp | Clexane (Enoxaparin) | Heparin (Unfractionated heparin) |
| Mechanism of Action | LMWH
Inactivates factor Xa and factor IIa (to a lesser degree) by potentiating anti-thrombin III. |
Primarily inactivating clotting factors IIa (thrombin) and factor Xa by reversibly binding to anti-thrombin III. |
| Dosage | 40 mg subcutaneously daily
20mg SC daily (dose reduced if <50kg or renal impairment) |
5000 units subcutaneously q8-12hrly |
| Indications | DVT prophylaxis
One injection daily More effective than unfractionated heparin in VTEp |
Injection twice daily |
| Contraindications | Renal impairment (eGFR <30) | Previous history of Heparin-induced thrombocytopenia (HITs) |
| Evidence of DVT prophylaxis is limited for extremes of weight so careful clinical consideration is required | ||
CEC – Venous Thromboemboli Risk Assessment Tool
UpToDate – Prevention of venous thromboembolic disease in adult nonorthopedic surgical patients
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