VTE prophylaxis Sharif-Kashani,B.MD SBMU

Preventing VTE Over 12 million people in the United States are at risk of VTE due to hospitalization for major surgery or medical illness According to most guidelines, appropriate prophylaxis (i.e., appropriate duration, dosage, and modality) is considered to be the most effective strategy for preventing VTE

Improving prophylaxis Hospital scoring systems Multidisciplinary teams Involving the Nursing team Audit and Feedback Real Life scenarios

In acutely ill medical patients, rivaroxaban was noninferior to enoxaparin for standard-duration thromboprophylaxis. Extended-duration rivaroxaban reduced the risk of venous thromboembolism. Rivaroxaban was associated with an increased risk of bleeding.

Risk and prevention of venous thromboembolism in adults with cancer Clinically apparent VTE occurs in as many as 10 percent of patients with cancer T he vast majority of VTE events occur in outpatients Cancer-associated VTE is associated with a higher mortality rate Do not use direct oral anticoagulants (eg, direct thrombin inhibitors or direct factor Xa inhibitors) in patients with cancer who are hospitalized with an acute medical illness Several scores for predicting the risk of VTE in ambulatory outpatients with cancer have been developed such as the Khorana score Routine outpatient prophylaxis is not recommended except in multiple myeloma treated with thalidomide or linalidomide or those who have a high Khorana score

Long-distance travel Long-distance travel, either by air or land, confers a two to fourfold increased risk of symptomatic venous thromboembolism The peak rate occurs within the first two weeks after travel Most individuals have one or more known risk factors for thrombosis Frequent ambulation and calf exercises, avoidance of dehydration or sedatives and graduated compression stockings