A separate page covers therapeutic anticoagulation.
An assessment of the requirement for thromboprophylaxis should be made on all patients at the time of admission.
|LOW RISK||MEDIUM RISK||HIGH RISK|
|Minor ilness at any age||Medical patients with any additional risk factor||Acute illness causing lower limb paralysis|
|Early mobilisation||s/c enoxaparin 20mg daily||s/c enoxaparin 20mg* daily +/- TED stockings|
ADDITIONAL PATIENT RISK FACTORS
|Age >40 years||Heart failure|
|Pregnancy||Recent myocardial infarction|
|Malignancy (esp. pelvic, abdo, metastatic)||Inflammatory bowel disease|
|Marked obesity||Certain other conditions: eg Paroxysmal nocturnal haemoglobinuria, Behcet’s disease, Homocystinaemia, Paraproteinaemia with hyperviscosity|
|Paralysis of lower limb(s)|
|High dose oestrogens|
Use enoxaparin with great caution (or not at all; or consider unfractionated heparin) in patients with acute renal failure or other condition that is not fully diagnosed or understood. This protocol recommends lower doses in high risk patients with renal impairment because of increased half life and possibly exacerbated effects in patients with renal failure. More information on anticoagulation in renal failure.
Thromboprophylaxis should be stopped 1 full day before renal biopsy (ie no dose within 24h).
Note that the risk of heparin may outweigh the benefits in some moderate and high risk patients.
|Contraindications to enoxaparin|
|Within 12 hours of invasive procedures where there is a danger of significant bleeding complications eg epidural/spinal anaesthesia, or surgery|
|Active peptic ulceration, recent intracranial haemorrhage or other excessive risk from bleeding|
|Coagulopathies and thrombocytopenia|
|Severe liver disease|
Acknowledgements: Lorna Thomson and Paddy Gibson were the main authors for this page. It was updated in November 2006 by LT and ANT. The last modified date is shown in the footer.