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VENOUS THROMBOEMBOLISM - PREVENTION

Venous thromboembolism is comprised of pulmonary embolism and deep venous thrombosis and is associated with significant morbidity and mortality.
All patients admitted for major trauma, surgery or acute medical illness should be assessed for risk of venous thromboembolism and bleeding before starting prophylaxis for venous thromboembolism.
Decision on which type of prophylaxis to be given must be individualized for each patient.

Venous%20thromboembolism%20-%20prevention Diagnosis

Diagnosis

Evaluation

Venous Thromboembolism (VTE) Risk Assessment Tools

Padua Risk Assessment Prediction Score

Used to assess hospitalized patients’ risk for VTE
Scores ≥4 indicated high VTE risk

Points	Medical History
3	Cancer, past VTE, immobile, thrombophilic
2	History of trauma or surgery 1 month prior to assessment
1	Age ≥70 years, congestive heart failure (CHF), acute myocardial infarction (MI), ischemic cerebrovascular accident, BMI ≥30, hormonal therapy, infections, rheumatologic diseases

Adapted from Institute for Clinical Systems Improvement. Venous thromboembolism prophylaxis guideline. 2012.

Pharmacoprophylaxis is suggested in patients at high risk for VTE but at low risk for bleeding
Patients at high risk for both VTE and bleeding should also be given intermittent pneumatic compression
No prophylactic measures are needed for patients at low risk for VTE and/or bleeding

Caprini VTE Risk Assessment

Used to assess the risk for VTE of patients scheduled for surgery
Points are given depending on different risk factors

Risk factors equivalent to 1 point each:

Age 41-60 years
Elective minor surgical procedure
Minor surgery <1 month prior
Varicose veins
History of inflammatory bowel disease
Edematous lower extremities
Obesity (BMI >25)
Acute MI
CHF <1 month prior
Sepsis <1 month prior
Serious pulmonary disease including pneumonia <1 month prior
Abnormal lung function [chronic obstructive pulmonary disease (COPD)]
Patient advised bed rest
Other risk factors

Risk factors equivalent to 2 points each

Age 61-74 years
Arthroscopic surgery
Present or history of malignancy
Major surgery of >45 minutes duration
Laparoscopic surgery of >45 minutes duration
Patient confined to bed for >72 hours
Plaster cast applied, immobilized for <1 month
Central venous access

Risk factors equivalent to 1 point each for female patients:

Oral contraceptive or hormonal therapy
Pregnant or <1 month postpartum
(+) stillborn birth, recurrent (>3) spontaneous abortion, premature birth with toxemia, growth restricted infant

Risk factors equivalent to 3 points each:

Age ≥75 years
History of DVT/PE
Family history of thrombosis
Positive factor V Leiden
Positive prothrombin A
Increased serum homocysteine
Positive lupus anticoagulant
Increased anticardiolipin antibodies
Heparin-induced thrombocytopenia
Congenital or acquired thrombophilia

Risk factors equivalent to 5 points each:

Elective major lower extremity arthroplasty
Hip/pelvis/lower extremity fracture of <1 month
Cerebrovascular accident <1 month
Multiple trauma <1 month
Acute spinal cord injury/paralysis <1 month

Adapted from Institute for Clinical Systems Improvement. Venous thromboembolism prophylaxis guideline. 2012.

VTE Risk Category	Caprini Score
Very Low	0
Low	1-2
Moderate	3-4
High	≥5

Other Medical Conditions

Acute MI (Please see Myocardial Infarction disease management chart for further information)
Acute stroke (Please see Ischemic Stroke and Intracerebral Hemorrhage disease management charts for further information)
Routine thromboprophylaxis is recommended in the following:
- Burn patients who have ≥1 additional VTE risk factors
- Intensive care unit (ICU) and septic patients
- Patients with severe respiratory disease

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