From the Guidelines
Non-surgical patients with multiple risk factors such as reduced mobility, active cancer, previous VTE, known thrombophilia, recent trauma or surgery, heart/respiratory failure, acute infection, obesity, or advanced age should receive DVT prophylaxis. The decision to provide prophylaxis is typically based on risk assessment tools like the Padua Prediction Score or IMPROVE VTE risk score 1. For high-risk patients, pharmacological prophylaxis with low molecular weight heparin (such as enoxaparin 40mg subcutaneously once daily), unfractionated heparin (5,000 units subcutaneously every 8-12 hours), or fondaparinux (2.5mg subcutaneously once daily) is recommended.
Some key considerations for DVT prophylaxis in non-surgical patients include:
- Most hospitalized patients with cancer require thromboprophylaxis throughout hospitalization 1
- Thromboprophylaxis is not routinely recommended for ambulatory patients with cancer; it may be considered for very select high-risk patients 1
- Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low molecular–weight heparin (LMWH) or low-dose aspirin to prevent venous thromboembolism (VTE) 1
- Patients should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE 1
For patients with contraindications to anticoagulation, mechanical prophylaxis with intermittent pneumatic compression devices should be used. Prophylaxis should continue until the patient regains mobility or risk factors resolve. This approach is important because hospitalized medical patients have a significant risk of developing venous thromboembolism, which can lead to serious complications including pulmonary embolism and death if not prevented. The American Society of Clinical Oncology guideline update provides key recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer, emphasizing the importance of risk assessment and individualized treatment plans 1.
From the FDA Drug Label
Prophylaxis of VTE in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding: 10 mg once daily, with or without food, in hospital and after hospital discharge for a total recommended duration of 31 to 39 days ( 2.1)
The medical criteria to determine non-surgical patient indications for Deep Vein Thrombosis (DVT) prophylaxis include:
- Being an acutely ill medical patient
- Being at risk for thromboembolic complications
- Not being at high risk of bleeding
These criteria are for the use of rivaroxaban, as stated in the drug label 2.
From the Research
Medical Criteria for Non-Surgical Patient Indications for DVT Prophylaxis
The medical criteria to determine non-surgical patient indications for Deep Vein Thrombosis (DVT) prophylaxis include:
- Assessing the risk of venous thromboembolism (VTE) in medical patients, as the risk increases with the number of risk factors 3
- Using evidence-based guidelines for VTE prophylaxis in medical patients, such as low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) 3
- Considering the use of non-pharmacological methods, such as basic physiotherapy, in patients with contraindications to pharmacologic prophylaxis 4
- Evaluating the risk-benefit ratio for VTE prophylaxis in medically ill patients, taking into account the potential for bleeding complications 5
Patient-Specific Factors
Patient-specific factors that influence the decision for DVT prophylaxis include:
- Renal impairment, which may require dose adjustment of LMWH 6
- Obesity, which may require higher doses of LMWH 6
- Contraindications to pharmacologic prophylaxis, such as bleeding disorders or active bleeding 4, 5
- Presence of other medical conditions, such as hemodialysis, which may affect the choice of prophylactic agent 7
Prophylactic Agents
The choice of prophylactic agent depends on various factors, including: