From the Guidelines
Deep vein thrombosis (DVT) prophylaxis methods include both pharmacological and mechanical approaches, with the most recent and highest quality study 1 recommending low molecular weight heparins, such as enoxaparin or dalteparin, as the first-line pharmacological option.
Methods of DVT Prophylaxis
The methods of DVT prophylaxis can be categorized into two main approaches: pharmacological and mechanical.
- Pharmacological options include:
- Low molecular weight heparins (LMWH) such as enoxaparin (40mg subcutaneously once daily or 30mg twice daily) or dalteparin (5000 anti-Xa IU o.d.)
- Unfractionated heparin (5000 units subcutaneously two or three times daily)
- Fondaparinux (2.5mg subcutaneously once daily)
- Direct oral anticoagulants such as rivaroxaban (10mg daily) or apixaban (2.5mg twice daily)
- Mechanical methods include:
- Graduated compression stockings that provide 15-30 mmHg of pressure
- Intermittent pneumatic compression devices worn on the legs
- Early mobilization of patients when possible
Choice of Prophylaxis
The choice of prophylaxis should be tailored to the patient's risk factors, including immobility, surgery type, cancer, previous DVT, obesity, and age.
- Pharmacological methods work by inhibiting the coagulation cascade
- Mechanical methods improve venous return and reduce blood stasis in the legs
- Prophylaxis should typically begin before or shortly after surgery and continue until the patient is fully mobile or discharged
Duration of Prophylaxis
The duration of prophylaxis may vary depending on the patient's risk factors and the type of surgery.
- Extended prophylaxis (up to 35 days) is recommended for high-risk patients such as those undergoing major orthopedic surgery 1
- The benefit of extended prophylaxis needs to be balanced against logistical challenges, such as travel, availability, refrigeration, and cost, especially in low-middle-income countries 1
From the FDA Drug Label
for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery. (1.2) Prophylaxis of DVT following hip or knee replacement surgery: The recommended dose is 2.5 mg orally twice daily. (2.1)
The method of DVT prophylaxis is apixaban at a dose of 2.5 mg orally twice daily for patients who have undergone hip or knee replacement surgery 2.
From the Research
Methods of DVT Prophylaxis
The following methods are used for Deep Vein Thrombosis (DVT) prophylaxis:
- Low-molecular-weight heparin (LMWH) preparations, such as enoxaparin and dalteparin, which are effective and safe in certain medical patients, as well as in general surgery and elective hip replacement 3, 4, 5
- Unfractionated heparin (UFH), which is adequate in some clinical settings but less effective in others 3
- Elastic stockings 6
- Intermittent pneumatic compression stockings 6
- Low-dose subcutaneous unfractionated heparin or low molecular-weight heparins, which can further reduce the incidence of DVT and pulmonary embolism (PE) 6
- Warfarin, which is an alternative to LMWH in the prevention of recurrences after DVT 7
Administration and Monitoring
- LMWH preparations can be administered subcutaneously once or twice daily, and do not require monitoring of the activated partial thromboplastin time or the International Normalized Ratio 3, 5
- UFH requires monitoring of the activated partial thromboplastin time 3
- The efficacy and safety of LMWH preparations have been demonstrated in various studies, with a low risk of bleeding complications 4, 5, 7
Patient Populations
- High-risk patients, such as those undergoing elective hip replacement, abdominal surgery, or those who are critically ill, can benefit from DVT prophylaxis with LMWH preparations 3, 4, 6
- Patients with a first episode of DVT, no risk factors for bleeding, and the ability to administer injections with or without the help of a visiting nurse or family member, can be treated with LMWH in the outpatient setting 5