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Venous thromboembolism (VTE) prophylaxis

Last reviewed: 14 Apr 2025
Last updated: 28 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • previous VTE, thrombophilia, malignancy, postoperative setting, trauma, and indwelling central catheter
  • chronic medical conditions, paresis, increasing age, obesity, estrogen-containing birth control pills and hormone replacement therapy, varicose veins, pregnancy and up to 6 weeks postpartum, first-degree relative with a history of VTE, extended travel, and admission to intensive care
Full details

Risk factors

  • previous VTE (deep vein thrombosis [DVT] and/or pulmonary embolism [PE])
  • thrombophilia
  • malignancy
  • postoperative setting
  • trauma
  • indwelling central catheter (upper or lower extremity)
  • immobility
  • myeloproliferative diseases
  • congestive heart failure
  • chronic obstructive pulmonary disease
  • inflammatory bowel disease (IBD)
  • neurologic disease with extremity paresis
  • increasing age
  • obesity
  • estrogen-containing birth control pills, hormone replacement therapy (HRT), and androgen deprivation therapy
  • history of varicose veins
  • pregnancy/postpartum
  • extended travel
  • lower leg immobility
  • first-degree relative with a history of VTE
  • admission to intensive care
Full details

Diagnostic tests

1st tests to order

  • CBC
  • serum creatinine
  • INR
  • PTT
Full details

Tests to consider

  • serum antiplatelet factor 4 antibodies
Full details

Treatment algorithm

INITIAL

all at-risk patients

ACUTE

trauma patients

surgical patients

medical patients

Contributors

Authors

Anna L. Parks, MD

Assistant Professor

Division of Hematology

University of Utah

Salt Lake City

UT

Disclosures

ALP declares that she has no competing interests.

Acknowledgements

Dr Anna L. Parks would like to gratefully acknowledge Dr Nathalie Routhier, Dr Vicky Tagalakis, Dr Farah Zarka, Dr Vincent Bouchard-Dechêne, and Dr Adi J. Klil-Drori, previous contributors to this topic.

Disclosures

NR, FZ, VBD, and AJKD declare no competing interests. VT has received honoraria from BMS Pfizer and Bayer. She has developed educational materials for Thrombosis Canada. VT is an author of references cited in this topic.

Peer reviewers

Andrew Parfitt, MBBS, FFAEM

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident Emergency Medicine

St Thomas' Hospital

London

UK

Disclosures

AP declares that he has no competing interests.

Sudeep Shivakumar, MD

Hematologist

Thrombosis Fellow

University of Ottawa

Ottawa Health Research Institute

Ottawa

Canada

Disclosures

SS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e278S-325.Full text  Abstract

Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141 (2 Suppl):e195S-226S.Full text  Abstract

National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Aug 2019 [internet publication].Full text

Nicolaides AN, Fareed J, Spyropoulos AC, et al. Prevention and management of venous thromboembolism. International consensus statement (guidelines according to scientific evidence). Int Angiol. 2024 Feb;43(1):1-222.Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Guidelines

    • NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease
    • Venous thromboembolism in cancer patients: ESMO clinical practice guideline​
    More Guidelines
  • Patient information

    Deep vein thrombosis

    DVT and long-distance travel

    More Patient information
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    More videos
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