What are the guidelines for DVT prophylaxis in severe septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

The Severe Sepsis Campaign guidelines have the following recommendations or suggestions regarding prophylaxis of deep vein thrombosis (DVT) in patients with sepsis [11, 60] :

  • In the absence of contraindications (eg, active bleeding or thrombocytopenia), administer either low-dose unfractionated heparin (UFH; 2 or 3 times daily) or low-molecular-weight heparin (LMWH); LMWH may be preferred in very high risk patients (eg, patients with sepsis and previous DVT, trauma, or orthopedic surgery)

  • If the patient’s creatinine clearance is less than 30 mL/min, dalteparin may be used

  • In the presence of contraindications for heparin use and in the absence of other contraindications, use mechanical DVT prevention devices (eg, graduated compression stockings [GCS] or intermittent compression devices [ICDs])

  • In very high risk patients, consider combining pharmacologic and mechanical prophylactic therapy unless contraindications exist or such therapy would be impractical

(See Deep Venous Thrombosis, Thromboembolism, and General Principles of Anticoagulation in Deep Venous Thrombosis.)


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