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...