J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Original Article

Volume 4, Number 4, December 2015, pages 223-227

Monitoring of Thromboembolic Events Prophylaxis: Where Do We Stand?

**Table 1.** Categories of Risk Groups for Venous Thromboembolism in Inpatients
	Characteristics	Suggested thromboprophylaxis option
Low risk groups	Minor surgery (< 30 min); no risk factor other than age Major surgery (> 30 min); age < 40 years; no other risk factors Minor trauma or medical illness	No specific thromboprophylaxis; early and “aggressive” ambulation
Moderate risk groups	Major general, urological, gynecological, cardiothoracic, vascular, or neurological surgery; age ≥ 40 years or other risk factor Major medical illness: heart or lung disease, cancer, inflammatory bowel disease Major trauma or burns Minor surgery, trauma or illness in patients with previous deep vein thrombosis, pulmonary embolism, or thrombophilia	LMWH (enoxaparin; 40 mg SC QD/30 mg SC BID), LDUH (5,000 UI) BID or TID, fondaparinux
High risk groups	Fracture or major orthopedic surgery of pelvis, hip, or lower limb Major pelvic or abdominal surgery for cancer Major surgery, trauma, or illness in patients with previous deep vein thrombosis, pulmonary embolism, or thrombophilia Lower limb paralysis (for example, hemiplegic stroke, paraplegia) Major lower limb amputation	LMWH (enoxaparin; 40 mg SC QD/30 mg SC BID), fondaparinux, oral vitamin K antagonist (INR 2 - 3)

Table 1. Categories of Risk Groups for Venous Thromboembolism in Inpatients

Characteristics

Suggested thromboprophylaxis option

Low risk groups

Minor surgery (< 30 min); no risk factor other than age
Major surgery (> 30 min); age < 40 years; no other risk factors
Minor trauma or medical illness

No specific thromboprophylaxis; early and “aggressive” ambulation

Moderate risk groups

Major general, urological, gynecological, cardiothoracic, vascular, or neurological surgery; age ≥ 40 years or other risk factor
Major medical illness: heart or lung disease, cancer, inflammatory bowel disease
Major trauma or burns
Minor surgery, trauma or illness in patients with previous deep vein thrombosis, pulmonary embolism, or thrombophilia

LMWH (enoxaparin; 40 mg SC QD/30 mg SC BID), LDUH (5,000 UI) BID or TID, fondaparinux

High risk groups

Fracture or major orthopedic surgery of pelvis, hip, or lower limb
Major pelvic or abdominal surgery for cancer
Major surgery, trauma, or illness in patients with previous deep vein thrombosis, pulmonary embolism, or thrombophilia
Lower limb paralysis (for example, hemiplegic stroke, paraplegia)
Major lower limb amputation

LMWH (enoxaparin; 40 mg SC QD/30 mg SC BID), fondaparinux, oral vitamin K antagonist (INR 2 - 3)

**Table 2.** Risk Factors of Patients and Prophylaxis According to Risk Categories in Guidelines
Risk category	Low risk	Moderate risk	High risk	Overall	P-value
Number of patients (%)	117 (38.4%)	171 (56.1%)	17 (5.6%)	305 (100%)	0.001
Age (years)	50.1 ± 19.1	66.3 ± 16.7	52.2 ± 14.7	59.3 ± 19.2	0.001
Number of risk factors	1.82 ± 0.7	2.97 ± 0.7	3.3 ± 0.9	2.5 ± 0.9	0.001
Contraindications (%)	3 (2.6%)	5 (2.9%)	1 (5.9%)	9 (3%)	0.75
Prophylaxis (%)	38 (32.5%)	165 (95.9%)	17 (100%)	219 (71.8%)	0.001

Table 2. Risk Factors of Patients and Prophylaxis According to Risk Categories in Guidelines

Risk category

Low risk

Moderate risk

High risk

Overall

P-value

Number of patients (%)

117 (38.4%)

171 (56.1%)

17 (5.6%)

305 (100%)

0.001

Age (years)

50.1 ± 19.1

66.3 ± 16.7

52.2 ± 14.7

59.3 ± 19.2

0.001

Number of risk factors

1.82 ± 0.7

2.97 ± 0.7

3.3 ± 0.9

2.5 ± 0.9

0.001

Contraindications (%)

3 (2.6%)

5 (2.9%)

1 (5.9%)

9 (3%)

0.75

Prophylaxis (%)

38 (32.5%)

165 (95.9%)

17 (100%)

219 (71.8%)

0.001

**Table 3.** Identified Risk Factors for VTE in Patients Enrolled in the Study
Risk factors	Frequency (%)
Older than 40 years (%)	249 (81.6%)
Infection (%)	146 (47.9%)
Inactivity (%)	132 (43.3%)
Pulmonary disease (%)	87 (28.5%)
Surgery (%)	83 (27.2%)
Malignancy (%)	29 (9.5%)
Obesity (%)	15 (4.9%)
Cardiac infarction (%)	9 (3%)
Acute ischemic stroke (%)	6 (2%)
Hormone therapy (%)	6 (2%)
Heart failure (%)	6 (2%)
History of VTE (%)	6 (2%)
Acute rheumatic disorder (%)	1(0.3%)
Inflammatory bowel disease (%)	1 (0.3%)

Table 3. Identified Risk Factors for VTE in Patients Enrolled in the Study

Risk factors

Frequency (%)

Older than 40 years (%)

249 (81.6%)

Infection (%)

146 (47.9%)

Inactivity (%)

132 (43.3%)

Pulmonary disease (%)

87 (28.5%)

Surgery (%)

83 (27.2%)

Malignancy (%)

29 (9.5%)

Obesity (%)

15 (4.9%)

Cardiac infarction (%)

9 (3%)

Acute ischemic stroke (%)

6 (2%)

Hormone therapy (%)

6 (2%)

Heart failure (%)

6 (2%)

History of VTE (%)

6 (2%)

Acute rheumatic disorder (%)

1(0.3%)

Inflammatory bowel disease (%)

1 (0.3%)

**Table 4.** Prophylaxis According to Number of Risk Factors of Patients
Number of risk factors	Patients without prophylaxis	Patients with correct prophylaxis	Total (%)
Test for trend P < 0.05.
1	27 (72.9%)	0 (0.0%)	37 (100%)
2	46 (40.4%)	45 (39.5%)	114 (100%)
3	10 (9.25%)	87 (80.6%)	108 (100%)
4	39 (92.8%)	2 (4.7%)	42 (100%)
≥ 5	1 (25.0%)	2 (50.0%)	4 (100%)
Total	86 (28.2%)	173 (56.7%)	305 (100)

Table 4. Prophylaxis According to Number of Risk Factors of Patients

Number of risk factors

Patients without prophylaxis

Patients with correct prophylaxis

Total (%)

Test for trend P < 0.05.

27 (72.9%)

0 (0.0%)

37 (100%)

46 (40.4%)

45 (39.5%)

114 (100%)

10 (9.25%)

87 (80.6%)

108 (100%)

39 (92.8%)

2 (4.7%)

42 (100%)

≥ 5

1 (25.0%)

2 (50.0%)

4 (100%)

Total

86 (28.2%)

173 (56.7%)

305 (100)