From the Research
DVT prophylaxis can be safely administered to patients on dual antiplatelet therapy (DAPT) with careful consideration of bleeding risk, and the most recent evidence suggests that low-dose enoxaparin or dalteparin may be effective options. When considering DVT prophylaxis in patients on DAPT, it is essential to assess individual bleeding risk factors, including age, renal function, history of bleeding, and reason for DAPT (recent stent placement, acute coronary syndrome) 1.
Key Considerations
- Regular monitoring for signs of bleeding is crucial, particularly at injection sites, in urine, and stool.
- If minor bleeding occurs, consider reducing the anticoagulant dose rather than discontinuing it completely.
- For patients transitioning to outpatient care who still require DVT prophylaxis, low-dose direct oral anticoagulants may be considered, though with extreme caution and possibly at reduced doses.
- The rationale for continuing DVT prophylaxis despite DAPT is that antiplatelet therapy primarily affects platelet aggregation while anticoagulants target the coagulation cascade, addressing different aspects of thrombosis prevention.
Recommended Prophylaxis Options
- Low-dose enoxaparin (40mg subcutaneously once daily) or unfractionated heparin (5000 units subcutaneously every 8-12 hours) is recommended for most hospitalized patients on DAPT who require DVT prophylaxis.
- Dalteparin may be considered as an alternative to enoxaparin, as recent studies suggest comparable effectiveness in preventing VTE events 2.
- For patients with very high bleeding risk, mechanical prophylaxis with intermittent pneumatic compression devices should be considered instead of pharmacological options.
Evidence Summary
The most recent study on the topic, published in 2024, found that dalteparin and enoxaparin had similar incidence rates of VTE events in a real-world cohort of hospitalized adult inpatients 2. Another study published in 2019 found that low-dose LMWH reduced symptomatic and asymptomatic VTE, but the analysis of the effects on bleeding and adverse events remained inconclusive 3. Overall, the evidence suggests that DVT prophylaxis can be safely administered to patients on DAPT with careful consideration of bleeding risk, and that low-dose enoxaparin or dalteparin may be effective options.