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.