Venous Thromboembolism Prophylaxis – Adult – Inpatient/Ambulatory Appendix B. VTE Prophylaxis in Surgical Patients Caprini Risk Assessment Model 1 Point 2 Points 3 Points 5 Points Age 41-60 Age 61-74 Age ≥ 75 Acute spinal cord injury (< 1 mo) Acute MI (<1 mo) Central venous access Established thrombophilia Elective lower extremity arthroplasty BMI > 25 Immobile > 72 hrs HIT Hip, pelvis, or leg fracture (< 1 mo) CHF exacerbation (<1 mo) Leg plaster cast or brace Hx of VTE Stroke (< 1 mo) Hx of Inflammatory Bowel Disease Malignancy Family hx VTE (1 degree relative) Procedure with local anesthesia Surgery- arthroscopic Swollen legs or Varicose veins Surgery > 45 mins Sepsis (< 1 mo) Serious lung dx ex. Pneumonia (<1 mo) 1 point (For Women Only) Oral contraceptives or HRT Pregnancy or postpartum (< 1 month) Hx of unexplained stillborn infant, spontaneous abortion (≥3), premature birth with toxemia or growth restricted infant Points Risk Recommendation 0 Very Low VTE Risk Early and frequent ambulation 1-2 Low VTE Risk Mechanical Prophylaxis 3-4 Moderate VTE Risk and Low Bleed Risk Pharmacologic Prophylaxis > 5 High VTE Risk and Low Bleed Risk Mechanical AND Pharmacologic Prophylaxis > 2 High Bleed Risk Mechanical Prophylaxis VTE Prophylaxis Regimens for High VTE Risk General Surgery Patients Patient Population VTE Prophylaxis Regimens Preferred Option Alternative Option High VTE Risk Heparin 5000 units SQ every 8-12 hrsa Enoxaparin 40 mg SQ every 24 hrsa Renal impairment (CrCl < 30 mL/min)* *Not on hemodialysis Heparin 5000 units SQ every 8-12 hrsa Enoxaparin 30 mg SQ every 24 hrsb Bariatric Surgery Enoxaparin 40 mg SQ every 12 hrsa Heparin 5000 units SQ every 8-12 hrsc Major Trauma Enoxaparin 30 mg SQ every 12 hrsa Enoxaparin 0.5 mg/kg every 12 hrs Heparin 5000 units SQ every 8-12 hrsc Abdominal/Pelvic Surgery for Cancer Enoxaparin 40 mg SQ every 24 hrsb Heparin 5000 units SQ every 8-12 hrsc Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 03/2023 Effective 3/16/2023. Contact CCKM@uwhealth.org for previous versions High Bleed Risk Intermittent pneumatic compression devices (IPC)a Graduated compression stockings (GCS) or Venous foot pumps (VFP)c Cardiac Surgery Heparin 5000 units SQ every 8-12 hrs Enoxaparin 40 mg SQ every 24 hrs Craniotomy Intermittent pneumatic compression devices (IPC)a Graduated compression stockings (GCS) or Venous foot pumps (VFP)c Spinal Surgery Intermittent pneumatic compression devices (IPC)a Graduated compression stockings (GCS) or Venous foot pumps (VFP)c Thoracic Surgery Heparin 5000 units SQ every 8-12 hrs Enoxaparin 40 mg SQ every 24 hrs Trauma Surgery Enoxaparin 30 mg every 12 hrsa Enoxaparin 0.5 mg/kg every 12 hrs Heparin 5000 units SQ every 8-12 hrsc a: UW Health GRADE Moderate quality evidence, strong recommendation b: UW Health GRADE Low quality evidence, strong recommendation c: UW Health GRADE Low quality evidence, weak/conditional recommendation Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 03/2023 Effective 3/16/2023. Contact CCKM@uwhealth.org for previous versions