🩺🔑 As a critical care pharmacist, it's essential to identify patients who need venous thromboembolism (VTE) prophylaxis and those who should avoid it. Per CHEST Guidelines, prophylaxis is recommended for acutely ill hospitalized patients at high risk of thrombosis (e.g., hip replacement, obesity, cancer, advanced age), unless contraindicated (e.g., active bleeding).
- Heparin 💉 is a common choice for VTE prophylaxis:
- Dose: 5000 units SC q8h (no renal/hepatic dose adjustments).
- For obese patients (BMI ≥ 30 kg/m²), a higher dose of 7500 units SC q8h can be considered.
- Enoxaparin (Clexane) 💉
- Dose: 40 mg SC q24h.
- Obese patients? Click here! (NPS Blog)
- Renal adjustment: CrCl < 30 mL/min? Reduce to 30 mg SC q24h.
- Fondaparinux (Arixtra) 💊
- Contraindications: Weight < 50 kg or CrCl < 30 mL/min.
- Dose: 2.5 mg q24h.
- Rivaroxaban (Xarelto) offers convenience with oral dosing
- Dose: 10 mg PO q24h for VTE prophylaxis (FDA-approved).
- Note: Cost may limit access for some patients.
🔄 If chemical prophylaxis is contraindicated, mechanical prophylaxis (compression stockings, intermittent pneumatic compression devices) can help prevent clots by improving blood flow. 🦵✨
References
- Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-352.
- Badireddy M, Mudipalli VR. Deep Venous Thrombosis Prophylaxis. [Updated 2023 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534865.
- Laryea J, Champagne B. Venous thromboembolism prophylaxis. Clin Colon Rectal Surg. 2013;26(3):153-159.
