Supportive and Preventive Medicine

prophylaxis alone or pharmacological prophylaxis with intermittent pneumatic compression

devices. A majority of included patients were medical (>75%). The addition of mechanical

prophylaxis did not result in a difference in the incidence of proximal lower-limb DVT (adjusted

relative risk: 0.89; 95% CI, 0.58–1.36), pulmonary embolism (aRR 0.92; 95% CI, 0.32–2.06), and

the composite of lower limb DVT/pulmonary embolism (aRR 1.11; 95% CI, 0.85–1.44) (N Engl J

Med 2019;380:1305-15).

Either LDUH or low-molecular-weight heparin (LMWH) should be initiated in a critically ill patient

over no prophylaxis.

The 2018 American Society of Hematology guidelines recommend continuing VTE prophylaxis only

while patients remain admitted in the hospital, over continuing extended prophylaxis (Blood Adv

2018;2:3360-92).

Randomized trials of VTE prophylaxis in critically ill patients are summarized in Table 6.

Recommendations for VTE prophylaxis in trauma patients are summarized in Table 7.

Recommendations for VTE prophylaxis in the general and abdominal-pelvic surgical patient are

summarized in Table 8.

Anticoagulants commonly employed and their usual doses for VTE prophylaxis in nontrauma

populations (excluding Obstetrics) are summarized in Table 9.

Citation

Study Type

Population

Intervention

Screening

Methods

VTE Rates

Major

Bleeding

Rates

N Engl J Med

1996;335:701-7

Single-center

344 patients

with major

trauma

Enoxaparin

30 mg twice

daily vs.

LDUH 5000

units twice

daily

Venography

on days

10–14 and

US if VTE

suspected

Proximal DVT:

14.7% in LDUH

group vs. 6.2% in

enoxaparin group;

p=0.012

PE: 0% in LDUH

group vs. 0.8% in

enoxaparin group;

p=NR

0.6% in

LDUH

group vs.

2.9% in

enoxaparin

group;

p=0.12

2000;161:1109-

Multicenter,

double-blind

221 MV

patients

with COPD

(169 patients

evaluated)

Nadroparin

(weight

based) SC

daily vs.

placebo

Weekly

US and

venography

DVT: 15.5% in

nadroparin group

vs. 28.2% in placebo

group; p=0.045

5.6% in

nadroparin

group and

2.7% in pla-

cebo group;

p=0.28

Thromb

Haemost

2009;101:139-

Multicenter,

double-blind

1935 patients

with severe

sepsis

receiving

drotrecogin

alfa (activated)

LDUH 5000

units SC

twice daily

vs. enoxa-

parin 40 mg

SC daily vs.

placebo

US on day

4–6

DVT: 5.6% in LDUH

group vs. 5.9% in

enoxaparin group

vs. 7.0% in placebo

group; p=NS

PE: 0.4% in LDUH

group vs. 0.4% in

enoxaparin group

vs. 0.8% in placebo

group; p=NS

NR