Friday, November 16, 2007

UpToDate®: Prevention of venous thromboembolic disease

UpToDate®: Prevention of venous thromboembolic disease: "we recommend the following treatment programs for hospitalized medical patients:
* Graduated compression stockings should be considered for low risk patients [18,103]
* Heparin or warfarin is recommended for patients following myocardial infarction who have no other significant risk factors for venous thromboembolism [18,104]
* In acutely ill patients hospitalized with heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors (eg, active cancer, previous VTE, sepsis, acute neurologic disease, acute inflammatory disease), either low dose heparin or LMW heparin is recommended [18,79,80,85,105-107].
* On admission to a critical care unit, all patients should be assessed for their VTE risk; most should receive thromboprophylaxis.
* For patients with ischemic stroke and lower limb paralysis, low dose heparin or LMW heparin is recommended [18,47,106,108]. (See 'Medical complications of stroke', section on VTE prophylaxis).
* Intermittent pneumatic compression may be used for high risk patients who are at high risk for bleeding, although this recommendation is not based upon clinical trial data [109]"