Clinical diagnosis of

VTE Prophylaxis
• Mehanical
• Pharmacological
 Mechanical prophylaxis
• Mechanical methods may also be combined with
pharmacological prophylaxis to increase efficacy in
high-risk patients.
• Do not increase the risk of bleeding, mechanical
methods may be preferred in patients at increased risk
of bleeding from pharmacological prophylaxis.
• Eg
Anti-embolism stockings (thigh or knee length)
Intermittent pneumatic compression devices (thigh or
knee length).
 Anti embolism stocking
• Anti-embolism
compression stockings
are commonly referred
to as TED hose
• They are used to
support the venous
and lymphatic drainage
of the leg.
 Pre-caution
• Ensure that patients who need anti-embolism stockings have their legs
measured and that the correct size of stocking is provided. Anti-embolism
stockings should be fitted and patients shown how to use them by staff
trained in their use.
• Use anti-embolism stockings that provide graduated compression and
produce a calf pressure of 14–15 mmHg
• Encourage patients to wear their anti-embolism stockings day and night
until they no longer have significantly reduced mobility.
• Remove anti-embolism stockings daily for hygiene purposes and to inspect
skin condition. Inspect the skin two or three times per day.
• Discontinue the use of anti-embolism stockings if there is marking,
blistering or discolouration of the skin, pain or discomfort.
 Intermitten pneumatic device
• Technique to prevent
thrombosis in bedridden
patients. It uses an inflatable
device that squeezes the calf
when it inflates, preventing
pools of blood forming
behind the valves in the
veins, thus mimicking the
effects of walking.
 Pharmacological
• These include:
Standard unfractionated heparin (usually in
low dosage)
Low molecular weight heparins or heparinoids
Oral anticoagulants
Dextran 70
Unfractionate heparin LMW heparin/heparinoid Oral anticoagulant

•SC in a dose of 5000U •SC for prophylaxis of VTE. •The recommended

every 12 hours after the therapeutic range is 2.0 to
surgery. •They are effective as 2.5
once-daily injections
• Meta-analyses have •Used when heparin is
revealed that low dose •LMWH is less likely to contraindicated
heparin reduces the produce heparin-induced
incidence of all DVT and thrombocytopaenia and •require daily monitoring
PE. osteoporosis than (INR) or the prothrombin
unfractionated heparin time.
 Surgical patient
• Advise patients to consider stopping oestrogen-containing
oral contraceptives or hormone replacement therapy 4 weeks
before elective surgery. If stopped, provide advice on
alternative contraceptive methods.
• Consider regional anaesthesia for individual patients, in
addition to other methods of VTE prophylaxis, as it carries a
lower risk of VTE than general anaesthesia.
• Extend pharmacological VTE prophylaxis to 28 days
postoperatively for patients who have had major cancer
surgery in the abdomen or pelvi
DURATION OF PROPHYLAXIS

1. Specific antithrombotic prophylaxis should be continued for

at least 5 days or until hospital discharge if this is earlier than
5 days.
2. In high-risk patients, prophylaxis should be continued until
illness and immobility have resolved, or until hospital
discharge if this is earlier.
3. After hospital discharge, increased risk of VTE may continue
for several weeks in patients with continuing risk factors .In
such patient, consideration should be given by the doctor to
continue prophylaxis after discharge.
4. If the hospital team recommends prophylaxis after discharge,
they should communicate with the patient prior to discharge.