From the Guidelines
Yes, DVT prophylaxis should be used in patients with perforated diverticulitis, as the benefits of preventing potentially fatal pulmonary embolism generally outweigh the bleeding risks. For most hospitalized patients with perforated diverticulitis, low molecular weight heparin (LMWH) such as enoxaparin 40mg subcutaneously once daily or unfractionated heparin 5000 units subcutaneously every 8-12 hours is recommended, as supported by the ERAS society recommendations 1. Prophylaxis should be started upon admission and continued throughout the hospital stay, including the perioperative period if surgery is required.
Key Considerations
- The rationale for DVT prophylaxis in these patients is their high thrombotic risk due to the inflammatory state of perforated diverticulitis, immobility during hospitalization, and potential surgical intervention.
- Additionally, these patients often have other risk factors such as advanced age and comorbidities.
- For patients with high bleeding risk, mechanical prophylaxis with intermittent pneumatic compression devices should be used until bleeding risk decreases, as mechanical methods do not cause bleeding and may have advantages for patients at risk for VTE who cannot receive anticoagulant-based thromboprophylaxis 1.
Recommendations
- Patients should wear well-fitting compression stockings and have intermittent pneumatic compression, as recommended by the ERAS society guidelines 1.
- Pharmacological prophylaxis with LMWH should be used, as it has been shown to reduce the prevalence of symptomatic venous thromboembolism (VTE) and overall colorectal cancer mortality 1.
- Extended prophylaxis for 28 days should be considered for patients with colorectal cancer, as it has been shown to be cost-effective and reduce the prevalence of symptomatic DVT 1.
From the Research
DVT Prophylaxis in Perforated Diverticulitis
- The use of DVT prophylaxis in patients with perforated diverticulitis is not directly addressed in the provided studies 2, 3, 4, 5.
- However, study 6 discusses the use of fondaparinux for prevention of venous thromboembolism in high-risk trauma patients, which may be relevant to patients with perforated diverticulitis who are at high risk of DVT.
- The study found that fondaparinux was effective in reducing the incidence of DVT in high-risk trauma patients, with an overall incidence of DVT of 4.6% and only 1.2% in patients who received fondaparinux 6.
- It is essential to note that the decision to use DVT prophylaxis in patients with perforated diverticulitis should be based on individual patient risk factors and the clinical judgment of the healthcare provider.
- The provided studies focus on the management of perforated diverticulitis, including surgical options and medical therapy, but do not specifically address the use of DVT prophylaxis in this patient population 2, 3, 4, 5.