The routine implementation of thromboprophylaxis methods is recommended by international consensus statements
(Nicolaides AN. Int Angiol 2006;25:101-61; Geerts, et al. Chest 2004;126(3 Suppl):338S-400S)
Because of:
Thromboprophylaxis recommendations apply to groups of patients for whom the benefits of prophylaxis outweigh the risks
However, decisions for the individual patient are made by tempering expert recommendations with clinical judgement, taking into account each patient’s risk factors for VTE and for adverse consequences of prophylaxis. Alternatives to systematic thromboprophylaxis are:
Thromboprophylaxis methods are applied as long as the risk of VTE persists. For example, in certain surgical settings (e.g. in total hip replacement, hip fracture surgery or abdominal surgery for cancer), thromboprophylaxis may be necessary for as long as one month after surgery.
Table 1. Levels of Thromboembolism Risk and Recommended Thromboprophylaxis in Hospital Patients
| Levels of Risk | Patient characteristics | Suggested Thromboprophylaxis Options |
|---|---|---|
| Low risk | Minor surgery in mobile patients Medical patients who are fully mobile |
No specific thromboprophylaxis Early and “aggressive” ambulation |
| Moderate risk | Most general, open gynaecologic or urologic surgery patients Medical patients, bed rest or sick |
LMWH (at recommended doses), Low-dose UFH bid or tid, fondaparinux |
| Moderate VTE risk plus high bleeding risk | Mechanical thromboprophylaxis | |
| High risk | Hip or knee arthroplasty, Hip Fracture Surgery Major trauma, Spinal Cord Injury |
LMWH (at recommended doses), fondaparinux, oral vitamin K antagonist (INR 2–3) |
| High VTE risk plus high bleeding risk | Mechanical thromboprophylaxis |
Table reference. Geerts et al. Chest 2008; 133; 381-453
Attention: this classification system has limitations (Geerts et al. Chest 2004:126(3 Suppl):338S-400S). Therefore, experts support the implementation of group-specific prophylaxis routinely for all patients who belong to each of the major target groups, as stated in the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines (Geerts et al. Chest 2004:126(3 Suppl):338S-400S).