Supportive and Preventive Medicine

Risk Level for VTE

Risk of Bleeding

Prophylaxis

Very low (< 0.5%;

Rogers score < 7;

Caprini score 0)

Low

Early ambulation

Low (~1.5%; Rogers

score 7-10; Caprini

score 1 or 2)

Low

IPCD

Moderate (~3.0%;

Rogers score > 10;

Caprini score 3 or 4)

Low

LMWH, LDUH, or IPCD

High

IPCD

High (~6.0%; Caprini

score ≥ 5)

Low

LMWH or LDUH with elastic stockings or IPCD

Low with contraindications to

LMWH or LDUH

Low-dose aspirin, fondaparinux, or IPCD

High

IPCD until risk of bleeding abates; then pharmacologic

prophylaxis should be initiated

Agent

Dose in Patients with

Normal Renal Function

Dose in Patients with Renal

Impairmentb

Dose Adjustments in BMI >

40 kg/m2

Enoxaparin

40 mg SC daily

30 mg SC daily

CrCl > 30 mL/min/1.73 m2: 40

mg SC every 12 h or 0.5 mg/kg

every 12 h

CrCl < 30 mL/min/1.73 m2

(excluding HD, PD, CVVH): 40

mg SC every 24 h

Dalteparin

5000 units SC daily

Specific dosage adjustments have not

been recommended; accumulation

did not occur in critically ill patients

with severe renal insufficiency.

7500 units SC daily

LDUH

5000 units SC every 8–12 hr: Choosing between every 8 hr and

every 12 hr should be based on the patient’s risk of thrombosis

and bleeding

7500 units SC every 8 h

Fondaparinux

2.5 mg SC once daily for

patients weighing ≥ 50 kg

Contraindicated in patients

with weight < 50 kg

Contraindicated; however, doses

of 2.5 mg SC every 48 hr have

2017;37:1241-48).

5 mg SC once daily

aObstetric populations not included. bEstimated CrCl 20–30 mL/min/1.73 m2.

CrCl = creatinine clearance; CVVH = continuous veno-venous hemofiltration; HD = hemodialysis; LDUH = low-dose unfractionated heparin; PD = peritoneal dialysis;

SC = subcutaneous(ly).

Inability to communicate symptoms (impaired consciousness) and altered physical examination (edema)

make the diagnosis of symptomatic VTE challenging in the critically ill population. Routine screening

for VTE with ultrasonography is not recommended.