Management – Overview

The key principles in DVT prophylaxis include:

• Risk stratification – Assess all hospitalized patients for VTE risk factors like critical illness, malignancy, and prior VTE.
• Initiate prophylaxis – Use risk assessment models to determine optimal prophylaxis regimen. Balance thrombosis and bleeding risks.
• Non-pharmacologic options – Mechanical prophylaxis like compression stockings can be used alone in high bleeding risk patients or with pharmacologic prophylaxis.
• Pharmacologic options – Include anticoagulants like heparin, LMWH, fondaparinux, and DOACs. Selection depends on renal function, risk factors, and procedure type.
• Duration – VTE prevention should begin at admission and continue through discharge based on persisting risk factors. Extend pharmacologic prophylaxis up to 35 days after major orthopedic surgery.
• Monitoring – Assess for signs and symptoms of VTE, bleeding, HIT, and therapeutic levels for certain agents.

The rationale is to reduce preventable harm from hospital-associated VTE, which affects ~900,000 patients annually in the US. DVT prophylaxis guidelines evolve as new evidence emerges on optimal agents, dosing, timing, and duration.

Pharmacists play a crucial role in appropriate DVT prophylaxis by assessing risks, selecting optimal regimens, monitoring for toxicity and efficacy, educating patients, and ensuring smooth care transitions.