Thrombosis Prophylaxis

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
Patients with a history of DVT/PE/ thrombophilia move up one category

Age >40 years Heart failure
Pregnancy Recent myocardial infarction
Immobility Nephrotic syndrome
Malignancy (esp. pelvic, abdo, metastatic) Inflammatory bowel disease
Severe infection Polycythaemia
Marked obesity Certain other conditions: eg Paroxysmal nocturnal haemoglobinuria, Behcet’s disease, Homocystinaemia, Paraproteinaemia with hyperviscosity
Paralysis of lower limb(s)
High dose oestrogens
Prescribing notes 

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.

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