Venous thromboembolism (VTE) is a major health problem that affects about 900 000 patients in the United States annually and results in an estimated 300 000 deaths. Critically ill patients who receive VTE prophylaxis have a significantly lower risk of death than do those who do not receive VTE prophylaxis. In a recent study, the incidence of deep vein thrombosis (DVT) in critically ill patients without VTE prophylaxis was 11%.

Assess all patients upon admission for risk factors for VTE and bleeding and anticipate orders for VTE prophylaxis depending on the risk assessment.

Consider VTE prophylaxis for the following patients:

  • Acutely ill medical patients who are at increased risk: low-molecular-weight heparin (LMWH) or low-dose unfractionated heparin (LDUH) or fondaparinux

  • Acutely ill general surgery patients who are at increased risk: LMWH, LDUH, or mechanical prophylaxis

  • Critically ill patients: LMWH or LDUH

  • Patients with high...

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