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VTE Risk Assessment
VTE Risk Assessment
FACTORS ASSOCIATED WITH INCREASED BLEEDING Patient may not be a candidate for anticoagulant therapy & SCDs should be considered. Active Bleed, Ingestion of Oral Anticoagulants, Administration of glycoprotein IIb/IIIa inhibitors, History of heparin induced thrombocytopenia CLINICAL CONSIDERATIONS FOR THE USE OF SEQUENTIAL COMPRESSION DEVICES (SCD) Patient may not be a candidate for SCDs & alternative prophylactic measures should be considered. Patients with Severe Peripheral Arterial Disease, CHF, Acute Superficial DVT
Incidence of DVT
Prophylaxis Regimen Early ambulation Choose the following medication OR compression devices: Sequential Compression Device (SCD) Heparin 5000 units SQ BID Choose ONE of the following medications + / - compression devices: Sequential Compression Device (SCD) Heparin 5000 units SQ TID Enoxaparin/Lovenox: 40mg SQ daily (WT < 150kg, CrCl > 30mL/min) 30mg SQ daily (WT < 150kg, CrCl = 10-29mL/min) 30mg SQ BID (WT > 150kg, CrCl > 30mL/min) (Please refer to Dosing Guidelines on the back of this form) Choose ONE of the following medications PLUS compression devices: Sequential Compression Device (SCD) Heparin 5000 units SQ TID (Preferred with Epidurals) Enoxaparin/Lovenox (Preferred): 40mg SQ daily (WT < 150kg, CrCl > 30mL/min) 30mg SQ daily (WT < 150kg, CrCl = 10-29mL/min) 30mg SQ BID (WT > 150kg, CrCl > 30mL/min) (Please refer to Dosing Guidelines on the back of this form)
Joseph A. Caprini, MD, MS, FACS, RVT VTE Risk Factor Assessment Tool
2% 10-20%
3-4
Higher Risk
20-40%
5 or more
Highest Risk
40-80%
Date
Time
NON-PREGNANT PATIENTS Body weight < 150kg, CrCl > 30mL/min: Enoxaparin 40mg SQ daily Body weight < 150kg, CrCl = 10-29mL/min: Enoxaparin 30mg SQ daily Body weight > 150kg, CrCl > 30mL/min: Enoxaparin 30mg SQ BID PREGNANT PATIENTS Prevention of DVT:# Maternal body weight (start of therapy) < 75 kg: Recommend 30 mg SQ once daily until 20 weeks Recommend 30 mg SQ BID after 20 weeks Maternal body weight (start of therapy) > 75 kg: Recommend 40 mg SQ once daily until 20 weeks Recommend 40 mg SQ BID after 20 weeks # Wait 12 hours before regional anesthesia MONITORING RECOMMENDATIONS Patients who are obese (actual body weight > 150 kg) Patients who are pregnant Patients with renal insufficiency (creatinine clearance < 30 ml/min) Desired Level Indication (Draw 4 hours after the 4th dose)
Anti-factor Xa Level (units/ml) < 0.2 0.2 to 0.5 0.6 to 1 Prevention of DVT/PE 0.2 to 0.5 units/ml >1
Ideal Body Weight IBW, men = 50 kg + 2.3 (inches > 5 feet) IBW, women = 45.5 kg + 2.3 (inches > 5 feet)