Supportive and Preventive Medicine

Citation

Study Type

Population

Intervention

Screening

Methods

VTE Rates

Major

Bleeding

Rates

Blood Coagul

Fibrinolysis

2010;21:57-61

Single-

center,

double-blind

156 surgi-

cal patients

undergoing

major elective

surgery

LDUH 5000

units SC

twice daily

vs. enoxapa-

rin 40 mg SC

daily

US 5–7 days

after surgery

and when

clinically

indicated

DVT: 2.7% in LDUH

group vs. 1.2% in

enoxaparin group;

p=0.51

2.7% in

LDUH

group vs.

1.2% in

enoxapa-

rin group;

p=0.48

N Engl J Med

2011;364:1305-

Multicenter,

double-blind

3746 medical-

surgical

ICU patients

expected to

remain in the

ICU ≥ 3 days

(90% medical,

76% MV)

LDUH 5000

units SC

twice daily

vs. dalteparin

international

units SC

daily

US 2 days

after admis-

sion, twice

weekly, and

as clinically

indicated

Proximal DVT: 5.8%

in LDUH group vs.

5.1% in dalteparin

group; p=0.57

PE: 2.3% in LDUH

group vs. 1.3% in

dalteparin group;

p=0.01

5.6% in

LDUH

group vs.

5.5% in

daltepa-

rin group;

p=0.98

COPD = chronic obstructive pulmonary disease; DVT = deep venous thrombosis; LDUH = low-dose unfractionated heparin; MV = mechanically ventilated; PE =

pulmonary embolism; NR = not reported; NS = not significant; SC = subcutaneously; US = ultrasonography.

Risk Level for VTE

Risk of Bleeding

Prophylaxis

Low-moderate

Low

LMWH,a LDUH,a or IPCD (all preferred to no prophylaxis)

Highb

Low

LMWHa is the agent of choice unless contraindicated

The American Association for the Surgery of Trauma/

American College of Surgeons recommend VTE prophylaxis

with enoxaparin, with an empiric dose of 40 mg SC every 12

hr adjusted based on anti-Xa level. Lower doses of 30 mg SC

every 12 hr may be considered in patients > 65 years of age, <

50 kg, CrCl 30–60 ml/min or other risk factors for bleeding or

drug accumulation (J Trauma Acute Care Surg 2022;92:597-

604; J Trauma Acute Care Surg. 2020;89(5):971-981)

LDUHa is preferred in patients with a CrCl < 30 mL/min/1.73

m2

aIf LDUH or LMWH is contraindicated, mechanical prophylaxis with IPCD is preferred to no prophylaxis in the absence of lower-extremity injury.

bIncludes acute spinal cord injury, traumatic brain injury, pelvic fracture, long bone fracture, venous injury repair, and spinal surgery from trauma; pharmacologic

prophylaxis should be initiated as soon as possible, typically 24–48 hr after the event, but this may depend on the extent of bleeding on head computed tomography.

IPCD = intermittent pneumatic compression device; LMWH = low-molecular-weight heparin.