DVT (%) | PE (%) | ||||
---|---|---|---|---|---|
Level of Risk | Calf | Proximal | Clinical | Fatal | Successful Prevention Strategies |
Low risk: Minor surgery in patients <40 yr with no additional risk factors | 2 | 0.4 | 0.2 | <0.01 | No specific prophylaxis; early and aggressive mobilization |
Moderate risk: Minor surgery in patients with additional risk factors; surgery in patients 40-60 yr with no additional risk factors | 10-20 | 2-4 | 1-2 | 0.1-0.4 | LDUH q12h, LMWH <3400 U daily, GCS, or IPC |
High risk: Surgery in patients >60 yr, or 40-60 yr with additional risk factors (prior VTE, cancer, molecular hypercoagulability) | 20-40 | 4-8 | 2-4 | 0.4-1.0 | LDUH q8h, LMWH >3400 U daily, or IPC |
Highest risk: Surgery in patients with multiple risk factors (age >40 yr, cancer, prior VTE); hip or knee arthroplasty, HFS; major trauma; SCI | 40-80 | 10-20 | 4-10 | 0.2-5 | LMWH (>3400 U daily), fondaparinux, oral VKAs (INR, 2-3), or IPC or GCS + LDUH or LMWH |
DVT, deep venous thrombosis; GCS, graduated compression stockings; HFS, hip-fracture surgery; INR, international normalized ratio; IPC, intermittent pneumatic compression; LDUH, low-dose unfractionated heparin; LMWH, low-molecular-weight heparin; PE, pulmonary embolism; SCI, spinal cord injury; VKA, vitamin K antagonist; VTE, venous thromboembolism.
Adapted from Geerts WH, Pineo GF, Heit JA. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:338S-400S.
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