Venous thromboembolism (VTE) prophylaxis

It is important to monitor hospitalized patients daily for signs and symptoms of VTE. Noninvasive testing (venous duplex, V/Q scan, or computed tomography angiography) is recommended if VTE is suspected. Routine screening with these tests is not recommended in asymptomatic patients.

Patients receiving anticoagulation should be monitored for bleeding, especially in the postoperative setting. Bleeding can occur at the site of the surgery, from a gastric or duodenal ulcer, or at low molecular weight heparin (LMWH) or unfractionated heparin (UFH) injection sites. If bleeding is suspected, hemoglobin and coagulation parameters should be ordered and anticoagulation discontinued.

To detect heparin-induced thrombocytopenia (HIT), measurement of platelet count is recommended at least every other day for patients at highest risk for HIT, primarily postsurgical patients receiving prophylactic UFH. For surgical patients receiving either prophylactic LMWH or UFH catheter flushes, as well as medical patients receiving prophylactic UFH, platelet count monitoring at least every 2 to 3 days is recommended for 4 to 14 days following onset of prophylaxis. Routine platelet count monitoring is not recommended for medical patients receiving prophylactic LMWH (low risk).[3]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(suppl 2):e227S-77S. https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltext http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com ​ However, any patient receiving UFH or LMWH prophylaxis who develops either a venous or arterial thrombotic event, or a necrotic reaction at an injection site, must have a hemogram to measure platelets and assess for HIT.