Venous thromboembolism prophylaxis

VTE 有75%的PE是發生在NON-SURGICAL patient身上，而且VTE是可預防的阿！

危險因子包括:
1.advanced age
2.previous VTE
3.trauma
4.prolong immobility(包含major surgery,stroke,paralysis)
5.obesity
6.heart failure
7.pregnancy
8.inflammatory bowel disease
9.coagulation factor deficiency

預防方式


1.with severe respiratory disease
2.with CHF
3.bedridden加上有其他的危險因子
這三類病人，應預防性給予
- low-dose unfractionated heparin(UFH),5000 units SC q8H
- LMWH (enoxaparin 40mg SC 或 4000units SC daily) OR (dalteparine 5000units SC daily)
如果病人是contraindication to antocoagulation prophylaxis應用
- intermittent pneumatic compression
- compression stockings


在postoperative病人依發生VTE的risk不同，分成三個group
1.Low risk(minor procedure,<40yr,no other risk factor)
- early mobilization is recommended

2.Moderate risk(nonmajor procedure and 40-60yr or other risk factor)
(major procedure and <40yr)
-LDUH 5000 units SC bid 或 LMWH < 3400 units per day

3.High risk(nonmajor procedure,>60yr,and other risk factor)
(major procedure,>40yr,and other risk factor)
-LDUH 5000 units SC tid 或 LMWH > 3400 units per day再併用mechanical methods
注意！！單純只用aspirin來預防DVT是不適合的哦！！

出自washington manual 32th, page2