DVT Prophylaxis in the SICU

Posted by e-Medical PPT Saturday, July 14, 2012
Mechanical Prophylaxis
Mechanical Compression
No convincing evidence of mortality value over placebo.
Plantar vs. Calf 
DVT in 21.0% plantar vs. 6.5% calf (p = 0.009).
Knee-length vs. Thigh-length
Equivalent effect w improved compliance in KL group.
Mechanical vs. Chemical
OR 0.46 (CI 0.16-1.29) for all heparin vs. mechanical

Chemical Prophylaxis
Aspirin
Not recommended for DVT prophylaxis
Aspirin vs. LMWH
63% RRR among 205 ortho pts LMWH vs. ASA.
Among hip trauma pts, 44% vs. 28% ASA vs. LMWH
UFH and LMWH
   UFH decreases incidence of DVT by  20% over placebo
   LMWH decreases incidence of DVT by 30% over UFH.

Mechanism of Heparins
Unfractionated heparin inactivates both Factor IIa and Xa
LMWH has increased affinity for Factor Xa
Fondiparinux is only a pentasaccharide sequence

IVC Filters
IVCF Reasons for Use
Clot with active cerebral bleeding
Clot despite anticoagulation
Massive PE with chronically compromised pulmonary vasculature
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