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Recommendations Recommendations Recommendations Recommendations
RiskRisk RecommendationRecommendation
Ambulation (all pts)Ambulation (all pts)
IPC/GCS or,
UFH 5000 SQ q 12 hrs or,
Enoxaparin 40mg SQ daily
IPC/GCS or,
UFH 5000 SQ q 12 hrs or,
Enoxaparin 40mg SQ daily
IPC/GCS plus…
UFH 5000U SQ q 8 hrs; or
Enoxaparin 40 mg SQ daily or
Enoxaparin 30mg SQ q 12 hrs
Fondaparinux 2.5 mg SQ daily
IPC/GCS plus…
UFH 5000U SQ q 8 hrs; or
Enoxaparin 40 mg SQ daily or
Enoxaparin 30mg SQ q 12 hrs
Fondaparinux 2.5 mg SQ daily
IPC/GCS plus…
UFH 5000 SQ q 8 hrs
Enoxaparin 40mg SQ daily
Enoxaparin 30mg SQ q 12 hrs
IPC/GCS plus…
UFH 5000 SQ q 8 hrs
Enoxaparin 40mg SQ daily
Enoxaparin 30mg SQ q 12 hrs
Low (0-1)Low (0-1)
Moderate (2-3)
Moderate (2-3)
High (4-5)High (4-5)
Highest(>6)
Highest(>6)
VTE Prophylaxis VTE Prophylaxis
VTE Prophylaxis VTE Prophylaxis
Recommendations Recommendations Recommendations Recommendations
RiskRisk RecommendationRecommendation
Ambulation (all pts)Ambulation (all pts)
IPC/GCS or,
UFH 5000 SQ q 12 hrs or,
Enoxaparin 40mg SQ daily
IPC/GCS or,
UFH 5000 SQ q 12 hrs or,
Enoxaparin 40mg SQ daily
IPC/GCS plus…
UFH 5000U SQ q 8 hrs; or
Enoxaparin 40 mg SQ daily or
Enoxaparin 30mg SQ q 12 hrs
Fondaparinux 2.5 mg SQ daily
IPC/GCS plus…
UFH 5000U SQ q 8 hrs; or
Enoxaparin 40 mg SQ daily or
Enoxaparin 30mg SQ q 12 hrs
Fondaparinux 2.5 mg SQ daily
IPC/GCS plus…
UFH 5000 SQ q 8 hrs
Enoxaparin 40mg SQ daily
Enoxaparin 30mg SQ q 12 hrs
IPC/GCS plus…
UFH 5000 SQ q 8 hrs
Enoxaparin 40mg SQ daily
Enoxaparin 30mg SQ q 12 hrs
Low (0-1)Low (0-1)
Moderate (2-3)Moderate (2-3)
High (4-5)High (4-5)
Highest(>6)
Highest(>6)
Recommendations Recommendations Recommendations Recommendations
RiskRisk RecommendationRecommendation
Ambulation (all pts)Ambulation (all pts)
IPC/GCS or,
UFH 5000 SQ q 12 hrs or,
Enoxaparin 40mg SQ daily
IPC/GCS or,
UFH 5000 SQ q 12 hrs or,
Enoxaparin 40mg SQ daily
IPC/GCS plus…
UFH 5000U SQ q 8 hrs; or
Enoxaparin 40 mg SQ daily or
Enoxaparin 30mg SQ q 12 hrs
Fondaparinux 2.5 mg SQ daily
IPC/GCS plus…
UFH 5000U SQ q 8 hrs; or
Enoxaparin 40 mg SQ daily or
Enoxaparin 30mg SQ q 12 hrs
Fondaparinux 2.5 mg SQ daily
IPC/GCS plus…
UFH 5000 SQ q 8 hrs
Enoxaparin 40mg SQ daily
Enoxaparin 30mg SQ q 12 hrs
IPC/GCS plus…
UFH 5000 SQ q 8 hrs
Enoxaparin 40mg SQ daily
Enoxaparin 30mg SQ q 12 hrs
Low (0-1)Low (0-1)
Moderate (2-3)Moderate (2-3)
High (4-5)High (4-5)
Highest(>6)
Highest(>6)
VTE Prophylaxis VTE Prophylaxis
• General surgery
• Vascular surgery
• Gynecologic surgery
• Urologic surgery
• Laparoscopic surgery
• Orthopedic surgery
• General surgery
• Vascular surgery
• Gynecologic surgery
• Urologic surgery
• Laparoscopic surgery
• Orthopedic surgery
Specific Recommendations Specific Recommendations Specific Recommendations Specific Recommendations
• Neurosurgery
• Trauma
• Burns
• Medical patients
• Cancer patients
• Critical care
• Neurosurgery
• Trauma
• Burns
• Medical patients
• Cancer patients
• Critical care
VTE Prophylaxis VTE Prophylaxis
• Deep vein thrombosis
• Pulmonary embolism
• Deep vein thrombosis
• Pulmonary embolism
Venous Thromboembolism Venous Thromboembolism
Diagnosis Diagnosis Diagnosis Diagnosis
Venous DuplexVenous Duplex
Acute DVTAcute DVTAcute DVTAcute DVT
Acute DVTAcute DVTAcute DVTAcute DVTVenous DuplexVenous Duplex
Acute DVT: Diagnosis Acute DVT: Diagnosis
D-Dimer D-Dimer
99.1% 99.1% 14.1% 14.1% Low Low
89.0% 89.0% 38.6% 38.6% HighHigh
96.1% 96.1% 23.5% 23.5% Overall Overall
Negative Negative Positive Positive Clinical Probability Clinical Probability
Predictive Values Predictive Values
D-Dimer negative predictive values equal to venous duplex over 3 mos follow-upD-Dimer negative predictive values equal to venous duplex over 3 mos follow-up
Wells PS, et al
NEJM 2003;349:1227-35
Wells PS, et al
NEJM 2003;349:1227-35
Use of D-Dimer in the Diagnosis of DVTUse of D-Dimer in the Diagnosis of DVT
DVT Clinically UnlikelyDVT Clinically Unlikely
D-Dimer TestD-Dimer Test
UltrasoundUltrasound
PositivePositive NegativeNegative
DVT excluded(99% NPV)
DVT excluded(99% NPV)
NegativeNegativePositivePositive
Repeat ultrasound in 3-7 days
Repeat ultrasound in 3-7 days
TreatTreat
Modified from:Wells PS et alNEJM 2003;349:1227
Modified from:Wells PS et alNEJM 2003;349:1227
Use of D-Dimer in the Diagnosis of DVTUse of D-Dimer in the Diagnosis of DVT
DVT Clinically LikelyDVT Clinically Likely
Venous DuplexVenous Duplex
Treat DVTTreat DVT
PositivePositive NegativeNegative
D-DimerD-Dimer
Repeat venous duplex 3-7 daysRepeat venous duplex 3-7 days
NegativeNegative PositivePositive
DVT excludedDVT excluded
Modified from:Wells PS et alNEJM 2003;349:1227
Modified from:Wells PS et alNEJM 2003;349:1227
