VTE Prophylaxis Potential Contraindication to VTE Prophylaxis (INCLUDING BUT NOT LIMITED TO) Contraindications to pharmacologic Order mechanical prophylaxis prophylaxis? (See reverse) Y & document “opt out” reason on protocol Absolute Relative Other • Active hemorrhage • ICH in last 12 mos. • Immune-mediated • Recent acute major • Craniotomy in last 2 weeks HIT Re-evaluate risk daily N trauma • Intra-ocular surgery in last 2 • Recent arteriotomy • Spine or intracranial weeks • Anticipated What is patient’s risk for VTE: Low, Moderate/High or Very High? surgery in last 72 hrs • GI/GU bleed in last 30 days admission <48 hrs (See reverse) • Thrombolytics w/in • PLT <50K or coagulopathy last 24 hrs • End-stage liver • Active intracranial Low Moderate/High or Very High • Hypertensive emergency • Post-op bleeding concerns

Spinal/Epidural UFH 5000 units SQ q8h Y or The risk vs benefit of VTE prophylaxis must be considered in each patient. Are you sure Anesthesia? Enox 40mg SQ daily Contraindications must be interpreted with caution and analyzed on a case-by- there are no case basis. For example, if a patient has minor bleeding, but their risk of VTE is VTE risk exponentially greater, it may be advisable to implement pharmacologic VTE factors? N prophylaxis with UFH which has a short half-life and is reversible. Conversely, if (See reverse) a patient’s bleeding risk is deemed to be greater than clotting risk, mechanical BMI ≥ 40? Y CrCl ≤ 30ml/min? methods may be a better option. Call anticoagulation pharmacist to discuss if you have questions or are unsure (264-6970)

N N N Potential risk factors for VTE Y Y (INCLUDING BUT NOT LIMITED TO)

Underweight? Fonda 2.5mg SQ daily Acute medical illness MI Re-evaluate (<50 kg) Y or risk Enox 0.5 mg/kg SQ Age > 50 yrs Myeloproliferative disorder BID (very high risk) Anesthesia Nephrotic syndrome or Central venous catheter Obesity Mechanical N Call Enox 0.5 mg/kg SQ Dehydration Pregnancy or no clinical DAILY Diabetes Post-partum prophylaxis pharmacy (moderate/high risk) Erythropoesis-stimulating agents Rheumatic disease CrCl ≤ 30ml/min? to Estrogen-based contraceptives Sepsis discuss (Consider checking Sickle cell disease dosing HEPXA or Fonda UFH 5000 units SQ q8h Y N options History of VTE (family or patient) Spinal cord injury or Hormone replacement Call clinical pharmacy to Surgery (moderate to major) discuss dosing options Fonda 2.5mg SQ daily (moderate/high/very high risk) Immobility Thrombophilia (eg- FVL, Prot C def) or Inflammatory bowel disease Trauma UFH 5000 units SQ q8h (moderate/high risk) Lung disease (acute or chronic) or Enox 40mg SQ daily (moderate/high risk) Malignancy Varicose or Venous access Enox 30mg SQ BID (very high risk) Risk Level (No HEPXA or Fonda levels needed) Low: (<10% of our patients) ambulating as much as they would at home and have none of the VTE risk factors listed above

*UFH= unfractionated heparin Moderate/high: (most of our patients) all patients not at low or very high risk (Call Allison Burnett, PharmD with questions 306-8987) Other resources: Very high risk: hip/knee arthroplasty, hip fracture, trauma, spinal cord injury 1) Call your area PCAP 2) anticoagulant dosing guideline on pharmacy webpage https://hospitals.health.unm.edu/intranet/pharmacy/documents/anticoagulantdosingguideline