Primary prevention of VTE spans a spectrum
High mortality from VTE makes primary prevention appealing. Guidelines and assessment tools offer a variety of patient-specific strategies and agents.
PRACTICE RECOMMENDATIONS
› Consider the mild reduction in the risk of venous thromboembolism (VTE) provided by statins when contemplating their use for cardiovascular disease prevention. B
› Avoid testing for thrombophilia to determine the risk of VTE, except in pregnant patients who meet criteria for antiphospholipid syndrome or have a family history of VTE. B
› Recommend an intrauterine device or progestin-only pill for contraception if the patient’s risk of VTE is high. B
› Stratify hospitalized medical and nonorthopedic surgical patients by risk score to determine the need for VTE prophylaxis. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Trauma: VTE risk increases with severity
Trauma increases the risk of VTE considerably. A national study showed that 1.5% of admitted trauma patients experienced VTE during hospitalization and that 1.2% were readmitted for VTE within 1 year.49 As many as 32% of trauma patients admitted to the intensive care unit experience VTE despite appropriate prophylaxis.50 A Cochrane Review51 found that:
- prophylaxis significantly reduces DVT risk
- pharmacotherapeutic prophylaxis is more effective than mechanical prophylaxis
- LMWH is more effective than LDUH.
Guidelines recommend that major trauma patients receive prophylaxis with LMWH, LDUH, or IPC.46
CORRESPONDENCE
Michael J. Arnold, MD, CDR, MC, USN; Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Jacksonville, FL 32214; michael.arnold@usuhs.edu.
