From the Guidelines
Deep vein thrombosis (DVT) prophylaxis should include a combination of mechanical and pharmacological methods, with low molecular weight heparin (LMWH) or unfractionated heparin being recommended for patients undergoing major elective abdominal or pelvic surgery, as stated in the most recent guidelines 1.
DVT Prophylaxis Methods
- Mechanical prophylaxis: graduated compression stockings and intermittent pneumatic compression devices
- Pharmacological prophylaxis: LMWH, such as enoxaparin 40mg subcutaneously once daily, or unfractionated heparin 5,000 units subcutaneously every 8-12 hours
Patient Risk Factors
- Malignancy
- Obesity
- Pelvic surgery
- Pre-operative immunosuppressants
- Immobility
- Hypercoagulable state
Duration of Prophylaxis
- Continue until full mobilization for medical patients or 10-35 days for orthopedic surgery patients
- Extended prophylaxis (28 days) may be considered for high-risk patients, but the benefit must be balanced against logistical challenges and the risk of bleeding 1
Important Considerations
- Patients with renal impairment may require dose adjustments for LMWH or unfractionated heparin
- Direct oral anticoagulants (DOACs) like rivaroxaban or apixaban may be options for extended prophylaxis after orthopedic surgery
- Mechanical prophylaxis is particularly valuable for patients with contraindications to anticoagulants The most recent and highest quality study 1 provides the strongest evidence for DVT prophylaxis, and its recommendations should be prioritized in clinical practice.
From the FDA Drug Label
Laboratory Samples Addition of 70 to 150 units of heparin sodium per 10 to 20 mL sample of whole blood is usually employed to prevent coagulation of the sample. DVT Prophylaxis Samples: The recommended dosage for DVT prophylaxis samples is 70 to 150 units of heparin sodium per 10 to 20 mL sample of whole blood to prevent coagulation of the sample 2.
- Key Points:
- Heparin sodium is used to prevent coagulation in laboratory samples.
- The dosage is 70 to 150 units per 10 to 20 mL of whole blood.
- This is used for DVT prophylaxis samples to prevent clotting.
From the Research
DVT Prophylaxis Samples
- The use of low-molecular-weight heparin (LMWH) for deep vein thrombosis (DVT) prophylaxis has been studied in various patient populations, including trauma patients 3 and medically ill patients receiving hemodialysis 4.
- Studies have compared the efficacy and safety of LMWHs, such as enoxaparin and dalteparin, with unfractionated heparin (UFH) for DVT prophylaxis, with results showing that LMWHs are effective and safe alternatives to UFH 5, 6.
- A meta-analysis of individual patient data found that enoxaparin was associated with a reduced risk of total and symptomatic VTE compared with UFH in hospitalized medical patients, without an increased risk of major bleeding 7.
- The use of LMWHs for DVT prophylaxis has several advantages, including ease of administration, reduced need for monitoring, and potential cost savings 5, 6.
- Specific patient populations, such as those with traumatic brain injury or undergoing multiple invasive procedures, may benefit from LMWH prophylaxis, with studies showing that it is feasible, safe, and effective in these patients 3.