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Celia Castellanos CruzTransitional Resident

Reference:Henny Billett, MDDirector, Thrombosis Prevention & TreatmentProgramProfessor of Clinical MedicineAlbert EinsteinCollege of Medicine

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Why give prophylaxis?

Who should / should not get prophylaxis?

What products should we use?

What dose and for what duration?

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Thrombosis is a $1.5 billion/year potential problemThird leading cause of cardiovascular deathD irectives from the AACP 2008

Every hospital should develop a formal strategy that addresses VTE prevention (grade 1A)

Passive methods such as distribution of materials andeducational meetings not recommended as sole methods(grade 1B)

Joint Commission & CMSJOINT COMMISSION:

VTE ProphylaxisDay of or day after admission to hospital or ICUDischarge VTE discharge instructions

CMS NEVER EVENTS: (Preventable conditions for which CMS willnot make additional payment)

Last years entry: D VT or PE following TKR/THRSequelae of:

RecurrencePulmonary hypertensionPost-thrombotic syndrome

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* VTE at day 21

* VTE at day 21

VTE at day 21

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40-60% recentlydischarged

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Low Risk:For flights > 8 h (Grade 1C)

avoidance of constrictive clothingmaintenance of adequate hydrationfrequent calf muscle contraction.

High Risk:(Grade 2C)-

properly fitted, below-knee GC S (15-30mm Hg)Or a single prophylactic dose of LMWH on departure

For long-distance travelersthey recommend against the use of aspirin forVTE prevention (Grade 1B).

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H igh Risk Surgery T H R, TKR, HF SSpinal Cord Injury Trauma

Prolonged procedures

H igh Risk MedicalCHF

Severe respiratory diseaseConfined to bed with risk factors

Previous VTE Sepsis

Acute neurologic diseaseIBD

H ospitalized cancer patient

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They recommend against the use of aspirinalone as thromboprophylaxis against VTE forany patient group (Grade 1A).

For long-distance travelers, we recommendagainst the use of aspirin for VTE prevention

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Methods:Graduated compression stockingsIntermittent pneumatic compressionVenous foot pump

Mechanical methods of thromboprophylaxisshould be used primarily for patients at highbleeding risk (Grade 1A)Or possibly as an adjunct to anticoagulantthromboprophylaxis (Grade 2A).

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Why give prophylaxis? Its good for the patient, for the hospital/nursing home

Who should get prophylaxis?

Every inpatient in the geriatric population except those for whomthere is a contraindicationNursing home patients, just discharged patients, immobilized patients

With what? Not aspirin or mechanicals aloneU FH vs LMW H vs F ondaparinux

What dose/duration? H igher risk thrombosis/higher dose of AC if no contraindications

As long as the risk is high?