What is the role of thromboprophylaxis in the prevention of venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Thromboprophylaxis has been reported to reduce the incidence of DVT and fatal PE. Prophylaxis may be achieved with medication or with mechanical devices. Medical prophylaxis should begin either 12 hours before surgery or immediately after surgery and should be continued for 7-10 days. [66, 67, 68, 69, 70, 71, 72, 73, 74]

UFH given SC can reduce the incidence of thromboembolism. It must be administered two or three times daily, and bleeding can be a complication. LMWHs have a longer half-life and greater bioavailability than UFH does. The requirement for monitoring is less.

Data from an international, multicenter, randomized, controlled study found that a short-term course of thromboprophylaxis with the anticoagulant enoxaparin was more effective than an extended course of another anticoagulant, apixaban, with significantly fewer major bleeding events. [75]

Apixaban was approved by the FDA in December 2012 to reduce risk of stroke and systemic embolism associated with nonvalvular atrial fibrillation.

Danaparoid, a low-molecular-weight glycosaminoglycan, has been shown to be effective in preventing DVT and PE. It also has been used in patients whose treatment course has been complicated by HIT.

Warfarin is effective for thromboprophylaxis; it causes the depletion of vitamin K–dependent factors in the coagulation cascade. Warfarin requires close monitoring, and bleeding can be a complication. Dose-adjusted therapy should be monitored, keeping the INR in the range of 2.0-3.0.


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