RecommendationsRecommendations Risk Recommendation Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS or, UFH 5000.

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Presentation transcript:

RecommendationsRecommendations Risk Recommendation Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs Low (0-1) Moderate (2-3) High (4-5) Highest (>6) Highest (>6) VTE Prophylaxis

RecommendationsRecommendations Risk Recommendation Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs Low (0-1) Moderate (2-3) High (4-5) Highest (>6) Highest (>6)

RecommendationsRecommendations Risk Recommendation Ambulation (all pts) IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS or, UFH 5000 SQ q 12 hrs or, Enoxaparin 40mg SQ daily IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily IPC/GCS plus… UFH 5000U SQ q 8 hrs; or Enoxaparin 40 mg SQ daily or Enoxaparin 30mg SQ q 12 hrs Fondaparinux 2.5 mg SQ daily IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs IPC/GCS plus… UFH 5000 SQ q 8 hrs Enoxaparin 40mg SQ daily Enoxaparin 30mg SQ q 12 hrs Low (0-1) Moderate (2-3) High (4-5) Highest (>6) Highest (>6) VTE Prophylaxis

General surgery Vascular surgery Gynecologic surgery Urologic surgery Laparoscopic surgery Orthopedic surgery General surgery Vascular surgery Gynecologic surgery Urologic surgery Laparoscopic surgery Orthopedic surgery Specific Recommendations Neurosurgery Trauma Burns Medical patients Cancer patients Critical care Neurosurgery Trauma Burns Medical patients Cancer patients Critical care VTE Prophylaxis

Deep vein thrombosis Pulmonary embolism Deep vein thrombosis Pulmonary embolism Venous Thromboembolism DiagnosisDiagnosis

Venous Duplex Acute DVT

Venous Duplex

Acute DVT: Diagnosis D-Dimer 99.1% 14.1% Low 89.0% 38.6% High 96.1% 23.5% Overall Negative Positive Clinical Probability Predictive Values D-Dimer negative predictive values equal to venous duplex over 3 mos follow-up Wells PS, et al NEJM 2003;349: Wells PS, et al NEJM 2003;349:

Use of D-Dimer in the Diagnosis of DVT DVT Clinically Unlikely D-Dimer Test Ultrasound Positive Negative DVT excluded (99% NPV) DVT excluded (99% NPV) Negative Positive Repeat ultrasound in 3-7 days Repeat ultrasound in 3-7 days Treat Modified from: Wells PS et al NEJM 2003;349:1227 Modified from: Wells PS et al NEJM 2003;349:1227

Use of D-Dimer in the Diagnosis of DVT DVT Clinically Likely Venous Duplex Treat DVT Positive Negative D-Dimer Repeat venous duplex 3-7 days Repeat venous duplex 3-7 days Negative Positive DVT excluded Modified from: Wells PS et al NEJM 2003;349:1227 Modified from: Wells PS et al NEJM 2003;349:1227