risk factors for VTE? Consider IVC filter insertion in adults,. SCD only in peds due to low risk. Bleeding risk? (see ta
Regions Hospital Trauma Service Venous Thromboembolism Prophylaxis Protocol
Patient with one or more risk factors for VTE?
No
No prophylaxis, or consider SCD until ambulating if bedrest > 48 hrs
Yes May apply to uninjured upper extremities if lower extremities not available
Apply SCDs to lower extremities
Patient with two or more risk factors for VTE?
No, only 1 risk factor
SCD until discharge
Yes, 2 or more risk factors
DVT Surveillance at 72 hours, then weekly
Bleeding risk? (see table)
No
Enoxaparin > 12 Years Old 30mg SQ q12 hrs < 12 Years Old 0.5mg/kg SQ q12 hrs (max 30mg)
Yes
Consider IVC filter insertion in adults, SCD only in peds due to low risk
Consider conversion to coumadin when able (8 wk course) Goal INR = 1.6-1.8
Bleeding Risk VTE Risk Factors 1. History of DVT/PE 2. Repair/ligation of major venous injury 3. Coma 4. Spine fracture 5. Bedrest > 48 hrs 6. Complex or multiple lower extremity fractures 7. Pelvic fracture 8. Spinal cord injury 9. Age > 60
1. Intracranial hemorrhage or contusion within 48 hrs 2. Incomplete spinal cord injury 3. Nonoperative solid organ injury within 48 hrs 4. Eye injury within 7 days 5. Pelvic fx with significant hemorrhage, transfusion or embolization within 48 hrs 6. Coagulopathy 7. Ongoing resuscitation 8. Operative procedure -24 hrs prior through 24 hrs after procedure 9. Epidural catheter - 24 hrs pre- and post-insertion, and 24 hrs pre- and post-removal
