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VTE Risk Assessment

This document provides guidance for deep vein thrombosis (DVT) prophylaxis orders for elective general surgery patients. It includes an assessment of thrombosis risk factors and assigns point values to different risk factors. It then provides recommended prophylaxis regimens based on a patient's total risk factor score, ranging from low risk to highest risk. Prophylaxis options include early ambulation, compression devices, and anticoagulant medications. Contraindications and dosing guidelines for the anticoagulant enoxaparin are also outlined.

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283 views2 pages

VTE Risk Assessment

This document provides guidance for deep vein thrombosis (DVT) prophylaxis orders for elective general surgery patients. It includes an assessment of thrombosis risk factors and assigns point values to different risk factors. It then provides recommended prophylaxis regimens based on a patient's total risk factor score, ranging from low risk to highest risk. Prophylaxis options include early ambulation, compression devices, and anticoagulant medications. Contraindications and dosing guidelines for the anticoagulant enoxaparin are also outlined.

Uploaded by

priyopanji
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Deep Vein Thrombosis (DVT) Prophylaxis Orders

(For use in Elective General Surgery Patients)

BIRTHDATE NAME CPI No. SEX M F VISIT No. _____________________

Thrombosis Risk Factor Assessment (Choose all that apply)


Each Risk Factor Represents 1 Point
Acute myocardial infarction Age 41-60 years Swollen legs (current) Congestive heart failure (<1 month) Varicose veins Medical patient currently at bed rest Obesity (BMI >25) History of inflammatory bowel disease Minor surgery planned History of prior major surgery (<1 month) Sepsis (<1 month) Abnormal pulmonary function (COPD) Serious Lung disease including pneumonia (<1 month) Oral contraceptives or hormone replacement therapy Pregnancy or postpartum (<1 month) History of unexplained stillborn infant, recurrent spontaneous abortion (> 3), premature birth with toxemia or growth-restricted infant Other risk factors___________________ Subtotal:

Each Risk Factor Represents 2 Points


Central venous access Age 61-74 years Arthroscopic surgery Major surgery (>45 minutes) Malignancy (present or previous) Subtotal: Laparoscopic surgery (>45 minutes) Patient confined to bed (>72 hours) Immobilizing plaster cast (<1 month)

Each Risk Factor Represents 3 Points


Family History of thrombosis* Age 75 years or older History of DVT/PE Positive Prothrombin 20210A Positive Factor V Leiden Positive Lupus anticoagulant Elevated serum homocysteine Heparin-induced thrombocytopenia (HIT) (Do not use heparin or any low molecular weight heparin) Elevated anticardiolipin antibodies Subtotal: Other congenital or acquired thrombophilia If yes: Type_____________________________ * most frequently missed risk factor

Each Risk Factor Represents 5 Points


Multiple trauma (<1 month) Stroke (<1 month) Elective major lower extremity arthroplasty Subtotal: Hip, pelvis or leg fracture (<1 month) Acute spinal cord injury (paralysis) (<1 month)

TOTAL RISK FACTOR SCORE:

FACTORS ASSOCIATED WITH INCREASED BLEEDING Patient may not be a candidate for anticoagulant therapy & SCDs should be considered. Active Bleed, Ingestion of Oral Anticoagulants, Administration of glycoprotein IIb/IIIa inhibitors, History of heparin induced thrombocytopenia CLINICAL CONSIDERATIONS FOR THE USE OF SEQUENTIAL COMPRESSION DEVICES (SCD) Patient may not be a candidate for SCDs & alternative prophylactic measures should be considered. Patients with Severe Peripheral Arterial Disease, CHF, Acute Superficial DVT

Total Risk Factor Score 0-1 2

Risk Level Low Risk Moderate Risk

Incidence of DVT

Prophylaxis Regimen Early ambulation Choose the following medication OR compression devices: Sequential Compression Device (SCD) Heparin 5000 units SQ BID Choose ONE of the following medications + / - compression devices: Sequential Compression Device (SCD) Heparin 5000 units SQ TID Enoxaparin/Lovenox: 40mg SQ daily (WT < 150kg, CrCl > 30mL/min) 30mg SQ daily (WT < 150kg, CrCl = 10-29mL/min) 30mg SQ BID (WT > 150kg, CrCl > 30mL/min) (Please refer to Dosing Guidelines on the back of this form) Choose ONE of the following medications PLUS compression devices: Sequential Compression Device (SCD) Heparin 5000 units SQ TID (Preferred with Epidurals) Enoxaparin/Lovenox (Preferred): 40mg SQ daily (WT < 150kg, CrCl > 30mL/min) 30mg SQ daily (WT < 150kg, CrCl = 10-29mL/min) 30mg SQ BID (WT > 150kg, CrCl > 30mL/min) (Please refer to Dosing Guidelines on the back of this form)
Joseph A. Caprini, MD, MS, FACS, RVT VTE Risk Factor Assessment Tool

2% 10-20%

3-4

Higher Risk

20-40%

5 or more

Highest Risk

40-80%

Ambulatory Surgery - No orders for venous thromboembolic prophylaxis required

VTE Prophylaxis Contraindicated, Reason: _________________________________________________________

Physician Signature Processed By:

Dr. # Date/Time: White-Medical Record Yellow-MIS Pink-Pharmacy

Date

Time

DVT Prophylaxis Regimen

UMHS ENOXAPARIN DOSING GUIDELINES


o o o MUST wait 24 hours before starting Enoxaparin if patient has epidural catheter D/C Enoxaparin 10-12 hours prior to removing epidural catheter May restart Enoxaparin 24 hours after epidural catheter has been removed.

NON-PREGNANT PATIENTS Body weight < 150kg, CrCl > 30mL/min: Enoxaparin 40mg SQ daily Body weight < 150kg, CrCl = 10-29mL/min: Enoxaparin 30mg SQ daily Body weight > 150kg, CrCl > 30mL/min: Enoxaparin 30mg SQ BID PREGNANT PATIENTS Prevention of DVT:# Maternal body weight (start of therapy) < 75 kg: Recommend 30 mg SQ once daily until 20 weeks Recommend 30 mg SQ BID after 20 weeks Maternal body weight (start of therapy) > 75 kg: Recommend 40 mg SQ once daily until 20 weeks Recommend 40 mg SQ BID after 20 weeks # Wait 12 hours before regional anesthesia MONITORING RECOMMENDATIONS Patients who are obese (actual body weight > 150 kg) Patients who are pregnant Patients with renal insufficiency (creatinine clearance < 30 ml/min) Desired Level Indication (Draw 4 hours after the 4th dose)

Recommendations for Dose Alteration


Dose Adjustment Increase by 25 % No change Decrease by 20 % Hold for 3 hours, then decrease next dose by 30% Repeat Anti-factor Xa To Be Obtainted 4 hours after 4th dose Repeat in 1 week, then monthly thereafter 4 hours after 4th dose 4 hours after 4th dose

Anti-factor Xa Level (units/ml) < 0.2 0.2 to 0.5 0.6 to 1 Prevention of DVT/PE 0.2 to 0.5 units/ml >1

Ideal Body Weight IBW, men = 50 kg + 2.3 (inches > 5 feet) IBW, women = 45.5 kg + 2.3 (inches > 5 feet)

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