Up to 50% of patients don’t receive optimal VTE prophylaxis.
This is a big deal, since VTE is a leading cause of preventable deaths in the hospital.
Continue to promote early mobility.
Ask about using screening tools to identify high-risk patients...such as an immobile patient with a VTE history.
Management depends on bleeding and clot risk. In higher-risk patients, expect to add a med...mechanical prophylaxis...or both.
Medications. Anticipate giving unfractionated heparin...or enoxaparin (Lovenox) or another low-molecular-weight heparin. Both types of meds are given subcutaneously and work about as well as the other.
Warn about possible burning during injection. Alternate administration between the lower left and right “fatty” sides of the stomach...and don’t rub after injecting, since it may cause bruising.
Do NOT push out the air bubble in prefilled enoxaparin syringes before injecting. The bubble helps deliver the full dose.
Don’t expect much use of rivaroxaban (Xarelto) or other oral anticoagulants for VTE prevention in the hospital. They’re mainly used if prophylaxis will continue after discharge...such as after knee surgery.
Get our chart, Preventing Anticoagulation Errors, for monitoring advice...and ways to prevent errors, such as stopping PROPHYLAXIS if a heparin drip or another TREATMENT is started.
Mechanical. Expect use of mechanical prophylaxis (SCDs, etc) in patients at high bleed risk.
Try to ensure mechanical devices are worn for at least 18 hours/day. Troubleshoot concerns...such as evaluating if a larger cuff size is needed in patients with discomfort.
Screen for VTE risk at least daily. Younger, mobile, and other low-risk VTE patients may not need prophylaxis initially...but risks can change. For example, if a patient needs intubation, expect VTE prophylaxis will probably be added.
- Chest 2012;141(Suppl 2):e195S-e226S
- Chest 2012;141(Suppl 2):e227S-e277S
- Chest 2012;141(Suppl 2):e278S-e325S