DVT Prophylaxis Recommendations

Risk Stratification and Prophylaxis Selection

The American College of Physicians recommends standard prophylaxis options, including LMWH, low-dose UFH, or fondaparinux 2.5 mg once daily, continued for the duration of hospitalization (typically 6-14 days) for hospitalized medical patients at risk for DVT 1, 2
For patients with creatinine clearance ≥30 mL/min, the American Society of Clinical Oncology recommends using LMWH or fondaparinux; for those with renal insufficiency, unfractionated heparin is preferred 3
High bleeding risk patients should receive mechanical thromboprophylaxis with graduated compression stockings and/or intermittent pneumatic compression instead of pharmacologic agents, as recommended by the American College of Chest Physicians 1, 2
Rivaroxaban is not recommended for routine VTE prevention in acutely ill general medical patients, as it showed increased bleeding risk despite reducing VTE events, according to the American College of Cardiology 1

The American College of Surgeons recommends enoxaparin 30 mg subcutaneously twice daily starting 12 hours before or after surgery, continued for 10-14 days, with consideration for extension up to 35 days for orthopedic surgery patients 1
Fondaparinux 2.5 mg subcutaneously once daily starting 6-8 hours after surgery, continued for 10-14 days, with consideration for extension up to 35 days, is recommended by the American Academy of Orthopaedic Surgeons for orthopedic surgery patients 1

The American Society of Clinical Oncology recommends LMWH or fondaparinux (if CrCl ≥30 mL/min) or unfractionated heparin for medically-treated cancer patients with reduced mobility 3
Direct oral anticoagulants are not recommended routinely in this setting, according to the National Comprehensive Cancer Network 3
Pancreatic cancer patients (locally advanced or metastatic) should receive LMWH or direct oral anticoagulants (rivaroxaban or apixaban) for patients with low bleeding risk, as recommended by the American Society of Clinical Oncology 3

The American College of Obstetricians and Gynecologists recommends LMWH over warfarin for both prevention and treatment of VTE throughout pregnancy 4
Continue anticoagulation until delivery and reinitiate for at least 6 weeks postpartum (total duration ≥3 months), according to the American College of Obstetricians and Gynecologists 4
Fondaparinux should be avoided in pregnancy as it crosses the placenta, as recommended by the Society for Maternal-Fetal Medicine 5

Moderate-to-high thromboembolism risk patients (recent VTE <3 months, active cancer) should consider bridging anticoagulation, according to the American College of Cardiology 1
Discontinue warfarin 5 days before surgery; initiate bridging LMWH when INR <2.0, with last dose on the morning before surgery, as recommended by the American College of Surgeons 1

Catheter-related thrombosis can be prevented by ensuring right-sided jugular placement with catheter tip at SVC-right atrium junction, according to the American Society of Clinical Oncology 3
Inferior vena cava filters are not recommended for routine prophylaxis, as stated by the American College of Chest Physicians 3