Venous Thrombosis - Prevention

Prevention

Evidence supports the use of heparin in surgical patients whom have a high risk of thrombosis to reduce the risk of DVTs; however, the effect on PEs or overall mortality is not known. In hospitalized non-surgical patients, heparin results in an almost statistically significant decrease in mortality and may decrease the risk of PE and DVT, but it increases major bleeding events yielding little or no overall clinical benefit. It does not appear however to decrease the rate of symptomatic DVTs. In hospitalized non-surgical stroke patients, mechanical measures (compression stockings) resulted in skin damage and no clinical improvement. Data on the effectiveness of compression stockings among hospitalized non-surgical patients without stroke is scarce.

A 2011 clinical guideline from the American College of Physicians (ACP) gave three strong recommendations with moderate quality evidence on VTE prevention in non-surgical patients: that hospitalized patients be assessed for their risk of thromboembolism and bleeding before prophylaxis (prevention); that heparin or a related drug is used if potential benefits are thought to outweigh potential harms; and that graduated compression stockings not be used. As an ACP policy implication, the guideline stated a lack of support for any performance measures that incentivize physicians to apply universal prophylaxis without regard to the risks.

Despite development of various practice guidelines for prevention of VTE, they remain underused in most countries.