NYPH Recommended DVT Prophylaxis Regimen

Total Risk Factor Score 0-1 2 Incidence of DVT 10% 10-20% Risk Level Low Risk Moderate Risk Prophylaxis Regimen Options Out of Bed Ad Lib & Venodyne Segmental Compression Sleeves Enoxaparin injection 40 mg subcutaneous daily Dalteparin injection 2500 units subcutaneous daily UH 5000 units subcutaneous q12hr Fondaparinux (RESTRICTED) 2.5 mg subcutaneous daily, Consider Venodyne Segmental Compression Sleeves Enoxaparin injection 30 mg subcutaneous q 12h Dalteparin injection 5000 units subcutaneous daily Unfractionated Heparin 5000 units subcutaneous q 8h Fondaparinux (RESTRICTED) 2. 5mg subcutaneous daily and consider Venodyne Segmental Compression Sleeves

3 or Above

20-80%

High Risk

Enoxaparin 40 mg subcutaneous daily (PREVAIL Trial recommendations)

For Orthopedic patients only: Warfarin po, dose accordingly for INR 2-3

For Acute Ischemic Stroke only:

Prophylaxis Safety Considerations

Potential Medical Contraindications Patient is experiencing active bleeding or bleeding within past 72 hours Patient is at significant risk for major bleed Patients platelet count 50,000/mm3 Recent major procedure with significant concern for ongoing bleeding NOTE: If any of the above boxes are checked, the patient may not be a candidate for anticoagulant therapy and should be considered for alternative prophylactic measures (such as ambulation and Venodyne Segmental Compression Sleeves). Potential Mechanical Contraindications: Venodyne Segmental Compression Sleeves Patient has severe peripheral arterial disease Patient has acute DVT Patient has severe ulcers NOTE: It is recommended that mechanical methods of thromboprophylaxis be used primarily in patients at high risk of bleeding or as an adjunct to anticoagulant-based thromboprophylaxis. Specific Detail for Medical Contraindications: 1. Heparin Induced Thrombocytopenia (HIT) is a contraindication to heparin therapy, but patients may receive Fondaparinux. 2. Renal insufficiency (GFR <30) is a contraindication to LMWH, however Unfractionated Heparin can be safely used. 3. Dissecting or cerebral aneurysm 4. Bacterial endocarditits or pericarditis 5. Active peptic ulcer disease, ulcerative GI lesions 6. Hypertension: severe, uncontrolled, malignant, hypertensive crisis 7. Severe head trauma 8. INR or a PTT Ratio >1.5 (unless antiphospholipid antibodies) 9. Recent TURP 10. Eye, brain or spinal cord injury within past 48 hours 11. For Heparin or Enoxaparin: History of HIT 12. For Enoxaparin: Epidural catheter removal or spinal tap <2 hours prior to dose, weight <45kg; hemodialysis
Source: *Hirsch, J., et al, (2008) */Executive Summary*: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). /133(6) (Supplement):71S-109S, June 200.