Prevention of Deep Vein Thrombosis

Risk Assessment and Stratification

The American College of Chest Physicians recommends accurate risk stratification followed by appropriate prophylaxis for hospitalized medical and surgical patients at increased thrombotic risk, with options including pharmacologic anticoagulation, mechanical prophylaxis, and early mobilization 1, 2, 3
Patient-specific risk factors that increase DVT risk include age >60 years, active malignancy, previous history of VTE, obesity, restricted mobility, smoking, estrogen use, known thrombophilic disorder, and recent surgery or trauma 3, 4, 5

For acutely ill hospitalized medical patients at increased risk of thrombosis, the American College of Chest Physicians recommends anticoagulant thromboprophylaxis with LMWH, LDUH, or fondaparinux 1, 2, 6
The American College of Chest Physicians recommends against extended prophylaxis in medical patients, with duration of prophylaxis not extending beyond the period of patient immobilization or acute hospital stay 1, 5, 7

For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or at high risk for major bleeding, the American College of Chest Physicians recommends mechanical thromboprophylaxis with graduated compression stockings or intermittent pneumatic compression 1, 6, 7, 8
The American College of Chest Physicians recommends early ambulation for low-risk patients, and implementation as a basic measure in all patients when feasible 3

For long-distance travelers at increased risk of VTE, the American College of Chest Physicians recommends frequent ambulation, calf muscle exercise, or sitting in an aisle seat, and use of properly fitted below-knee GCS providing 15-30 mm Hg pressure at the ankle during travel 1, 5, 7, 8
For chronically immobilized persons residing at home or in nursing homes, the American College of Chest Physicians recommends against routine thromboprophylaxis 1, 5, 7, 8

The American College of Chest Physicians recommends against routine screening of critically ill patients with ultrasound for DVT, as this is not a recommended preventive strategy 1, 5, 7
The American College of Chest Physicians advises against overuse of pharmacologic prophylaxis in low-risk patients, as this increases bleeding complications without meaningful benefit 4, 9