What is the variation of risk in patients undergoing deep venous thrombosis (DVT) prophylaxis?

Updated: Jul 25, 2019
  • Author: David A Forsh, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Answer

Low-risk patients have a score of 1 or less. These are individuals who are younger than 40 years who are undergoing a minor surgical procedure and have no additional risk factors. The risk of calf DVT in this group is estimated to be 2-5% without prophylaxis, and the risk of clinical pulmonary thrombosis is 0.2% No specific prophylaxis is required in this group other than early and aggressive mobilization.

Moderate-risk patients have a score of 2 or less. They are individuals in the above group who have additional risk factors or are aged 40-60 years who are undergoing nonmajor surgery and have no additional risk factors. Other risk factors are surgery requiring a tourniquet (eg, arthroscopy), lower-extremity fractures, cast immobilization, or spinal surgery.

Major surgery in patients younger than 40 years poses a moderate risk of DVT, which is estimated at 10-20%. The risk of clinical PE in this group is 1-2%. Successful prevention strategies in this group consist of low-dose UFH (LDUH; q12hr), LMWH (< 3400 U q24hr), and GCS or IPC.

High-risk patients have a score of 3 or 4 and include persons older than 60 years, as well as patients aged 40-60 years who have additional risk factors, such as previous VTE, malignancy, or hypercoagulability. The risk of calf DVT is estimated at 20-40% in this group, with clinical pulmonary embolism occurring in 2-4%. Successful prevention strategies in this group consist of LDUH (q8hr) and LMWH (>3400 U q24hr), with or without IPC.

The highest-risk patients have a score of 5 or greater; they are older than 40 years who have additional risk factors, who are undergoing hip or knee replacement surgery, or who have had hip fracture, open lower-leg fracture, multiple trauma, or spinal cord injury. Hip fracture patients have the highest risk of dying from a fatal PE. Additional risk factors may include a history of VTE, malignancy, or hypercoagulable state. These factors carry an estimated risk of calf DVT of 40-80% without prophylaxis, with clinical PE occurring in 4-10% and fatal PE in 0.2-5%.

Successful prevention strategies include LMWH (>3400 U q24hr), fondaparinux, and coumarins (INR 2-3). Dose-adjusted LDUH or LMWH may be used with or without IPC/GCS.

To see complete information on Deep Venous Thrombosis Risk Stratification, please go to the main article by clicking here.


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