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.