Skip Navigation
Text Size: A A A

Panel 6: Venous Thromboembolism Prophylaxis for the Medical Patient

Surgeon General's Workshop on Deep Vein Thrombosis

1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13

Return to Menu


 SLIDE 1: Venous Thromboembolism Prophylaxis for the Medical Patient
 

John Heit, MD
Professor of Medicine
Director, Coagulation Laboratories & Coagulation Clinic
Consultant, Cardiovascular Diseases and Hematology Research
Mayo Clinic College of Medicine Rochester, MN

Return to Top

 SLIDE 2: Annual Incidence of VTE in Olmsted County, MN: 1966-1995 By Age and Gender
 

Graph showing the annual incidence of VTE in Olmsted County, MN: 1966-1995 By Age and Gender

 

Return to Top

 SLIDE 3: Risk Factors for DVT or PE Nested Case-Control Study (n=625 case-control pairs)
 

Chart illustrating the risk factors for DVT or PE Nested Case-Control Study (n=625 case-control pairs)

 

Return to Top

 SLIDE 4: Incidence of VTE in Olmsted County, MN: 1966-1990

Location at onset
 Overall/
100,000
person-years		In hospitals /
100,000 bed-years		Community/
100,000
person-years
Overall *1179,60571
Men **13012,78077
Women **1106,58665
Deep Vein Thrombosis484,59336
Pulmonary69501235

* Adjusted to age and sex distribution of 1980 US whites.

** Adjusted to age distribution of 1980 US whites.

Return to Top

 SLIDE 5: VTE Risk Factors: Medical Patients

Characteristic

OR*

AR † (%)

Hospitalization for Acute Medical Illness10.521.5
Nursing Home Confinement2.313.3
Active Malignant Neoplasm
Without chemotherapy		5.26.4
Active Malignant Neoplasm
With chemotherapy		9.711.6
Central Venous Catheter/Transvenous Pacemaker5.99.1
Neurological Disease with Extremity Paresis6.16.9
Prior Superficial Vein Thrombosis3.85.4
*Odds Ratio
†Population-Attributable Risk
Heit, et al. Arch Intern Med 2000
Heit, et al. Arch Intern Med 2002

Return to Top

 SLIDE 6: VTE Risk Factors: Medical Patients
 

Characteristic

OR

95% CI*

Myeloproliferative Disorders5.101.14, 18.53
Nephrotic Syndrome2.741.09, 6.88
Inflammatory Bowel Disease2.820.95, 8.37
Oral Contraceptives2.650.98, 7.15
Pregnancy/Postpartum4.241.15, 15.61
Estrogen Therapy1.250.79, 1.97
Tamoxifen4.121.10, 15.43
*95% Confidence Interval
Heit, et al. Blood 2004

Return to Top

 SLIDE 7: Independent Risk Factors for Venous Thromboembolism Among Patients Hospitalized for Acute Medical Illness*(Olmsted County, MN)
 

Characteristic

OR

95% CI

P-value

Age (per 10 years increase in age)1.231.08, 1.400.001
Body Mass Index (kg/m 2; per 2-fold increase)2.731.52, 4.92<0.001
Neurological Disease with Extremity Paresis5.072.13, 12.07<0.001
Fracture4.061.62, 10.140.003
Chronic Renal Disease3.701.08, 12.670.037
Central Venous Catheter3.301.63, 6.70<0.001
Prior Superficial Vein Thrombosis2.461.19, 5.110.016
Immobility Requiring Physical Therapy2.301.30, 4.050.004
*After controlling for event year and active cancer.
Heit, et al. J Thromb Haemost 2005

Return to Top

 SLIDE 8: Relative Risk of VTE by Tumor Site
 

Tumor Site

Observed

Expected

RR

95%CI

Pancreas130.3537.019.7, 63.2
Lymphoma150.4731.817.8, 52.4
Brain30.1126.85.5, 77.9
Liver20.0824.02.9, 86.7
Leukemia80.3821.09.0, 41.3
Other digestive40.2417.04.6, 43.5
Other gynecologic70.5014.15.7, 19.1
Multiple myeloma20.1612.31.5, 44.4
Bladder70.6011.74.7, 24.2

Return to Top

 SLIDE 9: VTE Risk Factors: Nursing Home Residents

Characteristic

OR

95% CI

P-value

CHF0.900.41, 1.990.79
COPD1.140.48, 2.670.77
Diabetes0.590.25, 1.410.23
Malignancy1.770.83, 3.790.14
Neurological disease*1.000.27, 3.721.00
Parkinson’s disease0.270.06, 1.210.09
Fracture0.280.08, 1.010.05
Infection1.240.57, 2.730.59
Obesity1.110.37, 3.320.85

*Neurological disease included hemiplegia, multiple sclerosis, and cauda equina syndrome

Return to Top

 SLIDE 10: Parenteral Pharmacologic Prophylaxis

  • Unfractionated (Standard) Heparin (UFH)
  • Low-Molecular-Weight Heparin (LMWH)
    • enoxaparin sodium (Lovenox™)
    • dalteparin sodium (Fragmin ™)
    • (tinzaparin sodium [Innohep ™])

Return to Top

 SLIDE 11: Pharmacologic Prophylaxis

  • Parenteral-Indirect Factor Xa Inhibitor
    • fondaparinux (Arixtra™)
  • Parenteral-Direct Thrombin (IIa) Inhibitor
    • lepirudin (Refludan™)
    • argatroban
    • bivalirudin (hirulog)
  • Oral-warfarin sodium

Return to Top

 SLIDE 12: "Mechanical" Prophylaxis

  • Intermittent Pneumatic Compression (IPC)
    • calf only, or calf & thigh IPC
    • venous foot pump
  • Graduated Compression Stockings (GCS)
  • (Inferior Vena Cava [IVC] Filter)

  Return to Top

 SLIDE 13: Prophylaxis Recommendations Acutely Sick Medical Inpatients

  • UFH 5000 units subcutaneously three times daily or
  • LMWH according to recommended dose and dose schedule
  • GCS or IPC when anticoagulant prophylaxis is contraindicated

7thACCP Consensus Conference. Chest 2004

  Return to Top