Thromboprophylaxis

Blood Adv 2018;2:3198

Low-risk med; same-day surg & <40 y

Early, aggressive ambulation ± mechanical

Moderate-risk (hosp., ≥1 risk factor) or high-risk medical (hosp., ICU, cancer, stroke)

LMWH or UFH (if renal failure) or fonda (if HIT ⊕). Pharmacologic favored vs. mechanical, but may personalize based on bleeding & thrombotic risk.

Low-risk surgery (minor surgery)

Mechanical Ppx

Moderate-risk surgery (eg, major surgery, trauma, immobilization)

If low bleeding risk: LMWH or UFH SC

If high bleeding risk: mech Ppx

High-risk nonorthopedic surgery (multiple risk factors), stroke or ICH

[LMWH or UFH SC] + mech. Stroke s/p lytic or ICH: mech 24 h or until bleed stable, then + pharm.

Ortho surgery (cont pharmacoRx up to 35 d [hip] or 10–14 d [knee])

LMWH or DOAC (or fonda, UFH, or warfarin [INR 2–3]) + mech Ppx.

unfractionated heparin UFH: 5000 U SC bid or tid. Enoxaparin: 30 mg bid for highest risk or 40 mg qd for moderate risk or spinal/epidural anesthesia For rivaroxabn 10 mg/d, apixa 2.5 mg/d, edox 30 mg/d, dabi 110 mg post-op and then 220 mg/d.