The document discusses venous thromboembolism (VTE) risk assessment and prophylaxis for hospitalized medical patients. It provides recommendations from American Society of Hematology 2018 guidelines and Indonesian Thrombosis and Hemostasis Society 2018 national guidelines. The recommendations suggest using low molecular weight heparin or unfractionated heparin for VTE prophylaxis in acutely ill or critically ill medical patients based on their risk assessment scores. Mechanical prophylaxis alone or combined with pharmacological prophylaxis is conditionally recommended if patients cannot receive anticoagulants. Extended duration outpatient prophylaxis after hospital discharge is not routinely recommended.

1. VTE Risk Factor Assessment and
Prophylaxis

2. VTE (Venous Thromboembolic)
• Venous thromboembolism (VTE) refers to a blood clot that starts in a vein. It is the
third leading vascular diagnosis after heart attack and stroke.
• There are two types:
» Deep vein thrombosis (DVT) Deep vein thrombosis is a
clot in a deep vein, usually in the leg. DVT sometimes
affects the arm or other veins.
» Pulmonary embolism (PE) A pulmonary embolism occurs when
a DVT clot breaks free from a vein wall, travels to the lungs and
then blocks some or all of the blood supply. Blood clots
originating in the thigh are more likely to break off and travel to
the lungs than blood clots in the lower leg or other parts of the
body

3. • The most common triggers for venous thromboembolism are
surgery, cancer, immobilization and hospitalization.
• Certain groups are at higher risk for clotting:
• Older people
• People who are obese or overweight
• People with cancer or other conditions (including
autoimmune disorders such as lupus)
• People whose blood is thicker than normal because
their bone marrow produces too many blood cells

4. VTE Symptoms

5. Cause of VTE

6. Prevalence of VTE
• Venous thrombosis, including Deep Vein Thrombosis (DVT) and Pulmonary Embolism
(PE), occurs at an annual incidence of approximately 1 per 1,000 adults.
• The incidence increases markedly after around age 45 and is slightly higher in men than
in women at an older age.
• Based on research at Cipto Mangunkusumo Hospital in 2008, the prevalence of DVT in
Indonesia in post-gynecological surgery patients reached 33.3%.
• Indonesian Hemostatic Thrombosis Association / The Indonesian Society of Hemostatic
Thrombosis (INASTH). https://inasth.org/

7. VTE Epidemiology

8. VTE Risk Factor

9. • Blood tests: D-Dimer * Ultrasound of an arm or leg to look for DVT
• CAT scan of the chest using
IV contrast for presence of PE
How to Diagnose VTE

10. • The Padua Prediction Score was developed to estimate risk of venous thromboembolism
(VTE) in hospitalized medical patients. In the derivation study, 1180 patients were followed
for up to 90 days after admission to monitor for the development of VTE.
• The rate of VTE was:
– Low risk patients (score <4): 0.3%
– High risk patients (score ≥4): 2.2% (receiving thromboprophylaxis in hospital) and 11% (not
receiving appropriate in-hospital thromboprophylaxis)
Barbar, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. Journal of
Thrombosis and Haemostasis: JTH 2010, 8 (11): 2450-7
VTE Risk Assessment
Padua Score

11. Barbar, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. Journal of
Thrombosis and Haemostasis: JTH 2010, 8 (11): 2450-7
VTE Risk Assessment
Padua Score
Conclusion:
This RAM can help discriminate between medical patients at high and low risk of VTE. The
adoption of adequate thromboprophylaxis in high-risk patients during hospitalization leads
to longstanding protection against thromboembolic events with a low risk of bleeding.

12. • The IMPROVE [International Medical Prevention Registry on Venous Thromboembolism]
Predictive score was designed to assesses the risk of VTE in hospitalised medical patients.
• The IMPROVE Predictive score for VTE includes 4 independent risk factors for VTE present at
admission.
• The IMPROVE Associative score includes 7 variables present either at admission or during
hospitalization.
Spyropoulos AC, Anderson FA Jr, Fitzgerald G, Decousus H, Pini M, Chong BH, Zotz RB, Bergmann JF, Tapson V, Froehlich JB, Monreal M, Merli GJ, Pavanello R, Turpie AG,
Nakamura M, Piovella F, Kakkar AK, Spencer FA; IMPROVE Investigators. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest.
2011 Sep;140(3):706-14. doi: 10.1378/chest.10-1944. Epub 2011 Mar 24. PMID:21436241
VTE Risk Assessment
IMPROVE-VET Score

13. VTE Risk Assessment
IMPROVE-VET Score
Spyropoulos AC, Anderson FA Jr, Fitzgerald G, Decousus H, Pini M, Chong BH, Zotz RB, Bergmann JF, Tapson V, Froehlich JB, Monreal M, Merli GJ, Pavanello R, Turpie AG,
Nakamura M, Piovella F, Kakkar AK, Spencer FA; IMPROVE Investigators. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest.
2011 Sep;140(3):706-14. doi: 10.1378/chest.10-1944. Epub 2011 Mar 24. PMID:21436241

14. VTE Risk Assessment
IMPROVE-VET Score
Conclusion:
The IMPROVE VTE risk assessment model validation cohort revealed good discrimination
and calibration for bot the overall VTE risk model and the identification of low-risk and at-
risk medical patient groups, using a risk score of ≥3. More than two thirds of the entire
cohort had a score ≤2.

15. The Risk Assessment & The Prophylaxis

16. VTE Risk Assessment of Cancer Patients
• Risk stratification tools may help to reduce the number requiring treatment by guiding
selection of cancer patients at high risk of VTE.
• The best-known risk stratification tool is the Khorana score, which was introduced in 2008.
This score assigns points to five clinical and pre-chemotherapy laboratory parameters:
• Sum score of 0 points classifies patients as being at low risk of VTE, 1 or 2 points at
intermediate risk, and those with 3 or more points at high risk. The Khorana score is
endorsed by the latest guideline updates of the American Society of Clinical Oncology and the
National Comprehensive Cancer Network to select ambulatory cancer patients for
thromboprophylaxis
Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice
guideline update 2014. J Clin Oncol. 2015;33(6):654-656.
Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood.
2008;111(10):4902-4907.

17. Khorana Score
• The Khorana score was developed from a cohort of 2701 patients with cancer receiving a first
course of chemotherapy to predict the cumulative incidence of VTE at 2.5 months.
• The score was validated in a cohort of 1365 patients, most of whom (91%) had an ECOG
performance status of 0 or 1.
• The score was tested independently in 819 patients with newly diagnosed cancer or cancer
progression who had not received chemotherapy within the preceding 3 months to predict
the cumulative incidence of VTE at 6 months, and in 1415 patients enrolled in phase I clinical
trials followed for a median of 2 months.
Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-
associated thrombosis. Blood. 2008;111(10):4902-4907

18. KHORANA LITERATURE
Conclusion:
Khorana score can be used
to select ambulatory cancer
patients at high risk of
venous thromboembolism
for thromboprophylaxis;
however, most events occur
outside this high-risk group.

19. KHORANA LITERATURE
Conclusion:
• This is the first report validating KS as a risk tool to predict VTE in hospitalized
cancer patients.
• Using this tool could lead to more consistent and successful application of
inpatient thromboprophylaxis

20. VTE prophylaxis for hospitalized and
nonhospitalized medical patients
American Society of Hematology 2018
guidelines for management of venous
thromboembolism: prophylaxis for
hospitalized and non-hospitalized medical
patients
Holger J. Schünemann, Mary Cushman, Allison E. Burnett, Susan
R. Kahn, Jan Beyer-Westendorf, Frederick A. Spencer, Suely M.
Rezende, Neil A. Zakai, Kenneth A. Bauer, Francesco Dentali, Jill
Lansing, Sara Balduzzi, Andrea Darzi, Gian Paolo Morgano, Ignacio
Neumann, Robby Nieuwlaat, Juan J. Yepes-Nuñez, Yuan Zhang,
and Wojtek Wiercioch

21. Patient groups addressed in this chapter
Critically Ill Patient
Patients suffering from
immediately life-
threatening illness
requiring admission to
intensive care unit
Acutely Ill
Medical Patient
Patients hospitalized for
medical illness
Chronically Ill
Medical Patient
Those with medical
conditions who may be
cared for in long-term care
facilities
Long-distance
Traveler
Those traveling by air
for ≥ 4 hours

22. Who is at risk for VTE in hospital?
• Risk Assessment Models (RAMs) can identify inpatients at high
risk
• Examples: Padua, IMPROVE-VTE Scores
Padua RAM: Factors
Previous VTE
Thrombophilia
Active cancer
Age > 70 years
Reduced mobility
Recent trauma/surgery
Heart or respiratory failure
Acute MI or stroke
Hormonal treatment
Obesity (BMI > 30)
Infection/rheumatologic
IMPROVE-VTE RAM:
Factors
Previous VTE
Thrombophilia
Active cancer
Age > 60 years
Immobilization of ≥ 7
days
Lower limb paralysis
ICU/CCU stay
These RAMs are
not extensively
validated for
guiding decisions
about prophylaxis

23. Acutely ill medical patients:
pharmacological prophylaxis
• Recommendation 1, 2, and 3
– In acutely ill medical patients, the ASH guideline panel suggests using
UFH, LMWH, or fondaparinux rather than no parenteral anticoagulant
(conditional recommendation, low certainty in the evidence of
effects).
– Among these anticoagulants, the panel suggests using LMWH (low
certainty in the evidence of effects) or fondaparinux (very low
certainty in the evidence of effects) rather than UFH (conditional
recommendation).
• Remark: These 3 recommendations also apply to anticoagulant choices
when VTE prophylaxis is considered for patients with stroke.

24. Critically ill medical patients:
pharmacological prophylaxis
• Recommendation 4
In critically ill medical patients, the ASH guideline panel recommends
using UFH or LMWH over no UFH or LMWH (strong recommendation,
moderate certainty in the evidence of effects)
• Recommendation 5
In critically ill medical patients, the ASH guideline panel suggests using
LMWH over UFH (conditional recommendation, moderate certainty in
the evidence of effects)

25. Acutely or critically ill medical patients: mechanical VTE prophylaxis vs a
combination of pharmacological and mechanical or pharmacological VTE
prophylaxis alone
• Recommendation 6
In acutely or critically ill medical patients, the ASH guideline panel suggests using pharmacological
VTE prophylaxis over mechanical VTE prophylaxis (conditional recommendation, very low
certainty in the evidence of effects).
• Recommendation 7
In acutely or critically ill medical patients who do not receive pharmacological VTE prophylaxis,
the ASH guideline panel suggests using mechanical VTE prophylaxis over no VTE prophylaxis
(conditional recommendation, moderate certainty in the evidence of effects).
• Recommendations 8 and 9
In acutely or critically ill medical patients, the ASH guideline panel suggests pharmacological or
mechanical VTE prophylaxis alone over mechanical combined with pharmacological VTE
prophylaxis (conditional recommendation, very low certainty in the evidence of effects).
• Recommendation 10
In acutely or critically ill medical patients who are receiving mechanical VTE prophylaxis, the ASH
guideline panel suggests using pneumatic compression devices or graduated compression
stockings for VTE prophylaxis (conditional recommendation, very low certainty in the evidence of
effects

26. DOACs in acutely ill medical patients
• Recommendation 11
In acutely ill hospitalized medical patients, the ASH guideline panel
recommends using LMWH over DOACs as VTE prophylaxis (strong
recommendation, moderate certainty in the evidence of effects).
• Recommendation 12
In acutely ill hospitalized medical patients, the ASH guideline panel
recommends inpatient VTE prophylaxis with LMWH only, rather than
inpatient and extended duration outpatient VTE prophylaxis with DOACs
(strong recommendation, moderate certainty in the evidence of effects).
Remark: If patients are on a DOAC for other reasons, this
recommendation may not apply.

27. Extended-duration outpatient prophylaxis vs inpatient-only prophylaxis in
acutely ill medical patients
• Recommendation 13
In acutely ill medical patients, the ASH guideline panel recommends inpatient
over inpatient plus extended-duration outpatient VTE prophylaxis (strong
recommendation, moderate certainty in the evidence of effects).
Remark: This recommendation applies to heparin and DOACs.
Extended-duration outpatient prophylaxis vs inpatient-only UFH or LMWH
in critically ill medical patients
• Recommendation 14
In critically ill medical patients, the ASH guideline panel recommends inpatient
over inpatient plus extended-duration outpatient VTE prophylaxis (strong
recommendation, moderate certainty in the evidence of effects)

28. Chronically ill medical patients or nursing home patients
• Recommendation 15
In chronically ill medical patients, including nursing home patients, the ASH
guideline panel suggests not using VTE prophylaxis compared with using any VTE
prophylaxis (conditional recommendation, very low certainty in the evidence of
effects).
Remark: If a patient’s status changes to acute, other recommendations would
apply.
Medical outpatients with minor provoking risk factors for VTE
• Recommendation 16
In medical outpatients with minor provoking factors for VTE (eg, immobility,
minor injury, illness, infection), the ASH guideline panel suggests not using VTE
prophylaxis (conditional recommendation, very low certainty in the evidence of
effects)

29. Long-distance travelers
• Recommendation 17
In long-distance (>4 hours) travelers without risk factors for VTE, the ASH guideline panel
suggests not using graduated compression stockings, LMWH, or aspirin for VTE prophylaxis
(conditional recommendation, very low certainty in the evidence of effects).
Remark: People without known risk factors who place a high value on prevention of VTE
may choose to use graduated compression stockings (also reduces edema).
• Recommendation 18
In people who are at substantially increased VTE risk (eg, recent surgery, history of VTE,
postpartum women, active malignancy, or >2 risk factors, including combinations of the
above with hormone replacement therapy, obesity, or pregnancy), the ASH guideline panel
suggests using graduated compression stockings or prophylactic LMWH for longdistance
(>4 hours) travel (conditional recommendation, very low certainty in the evidence of
effects).
• Recommendation 19
In people who are at substantially increased VTE risk (eg, recent surgery, history of VTE,
postpartum women, active malignancy, or >2 risk factors, including combinations of the
above with hormone replacement therapy, obesity, or pregnancy) and in whom LMWH or
graduated compression stockings is not feasible (eg, resourceconstrained setting or aversion
to other indicated anticoagulants), the ASH guideline panel suggests using aspirin rather
than no VTE prophylaxis (conditional recommendation, very low certainty in the evidence of
effects)

30. PANDUAN NASIONAL TROMBOEMBOLI VENA PERHIMPUNAN TROMBOSIS DAN HEMOSTASIS INDONESIA (PTHI) 2018
VTE prophylaxis for hospitalized and
nonhospitalized medical patients

31. Rekomendasi Panduan Nasional
PTHI
• Manfaat pemberian profilaksis dengan LMWH (enoxaparin dan dalteparin) atau UFH
untuk pencegahan TEV pada pasien dengan faktor risiko
• Pemberian profilaksis dengan LMWH sama efektifnya dengan UFH dengan profil
keamanan yang lebih baik secara signifikan.
• Pada pasien medis risiko tinggi TEV yang tidak menghendaki pemberian antikoagulan
parenteral, dapat diberikan obat golongan DOAC (2C).
• Penggunaan profilaksis mekanik ditujukan pada pasien-pasien yang mempunyai
kontraindikasi untuk pemberian antikoagulan, seperti pada pasien dengan
perdarahan aktif dan trombositopenia berat.
PANDUAN NASIONAL TROMBOEMBOLI VENA PERHIMPUNAN TROMBOSIS DAN HEMOSTASIS INDONESIA (PTHI) 2018

32. Rekomendasi Panduan Nasional PTHI
PANDUAN NASIONAL TROMBOEMBOLI VENA PERHIMPUNAN TROMBOSIS DAN HEMOSTASIS INDONESIA (PTHI) 2018

33. Rekomendasi Panduan Nasional PTHI
PANDUAN NASIONAL TROMBOEMBOLI VENA PERHIMPUNAN TROMBOSIS DAN HEMOSTASIS INDONESIA (PTHI) 2018

34. Rekomendasi Panduan Nasional PTHI
PANDUAN NASIONAL TROMBOEMBOLI VENA PERHIMPUNAN TROMBOSIS DAN HEMOSTASIS INDONESIA (PTHI) 2018

35. Rekomendasi Panduan Nasional
PTHI
• Tromboprofilaksis pada umumnya
dilanjutkan sampai 6-14 hari atau selama
periode perawatan di rumah sakit.
• Data menunjukkan bahwa risiko TEV tetap
ada sampai pasien keluar dari rumah sakit.
PANDUAN NASIONAL TROMBOEMBOLI VENA PERHIMPUNAN TROMBOSIS DAN HEMOSTASIS INDONESIA (PTHI) 2018

37. Mahlab-Guri, K., Otman, M. S., Replianski, N., Rosenberg-Bezalel, S., Rabinovich, I., & Sthoeger, Z. (2020). Venous thromboembolism prophylaxis in
patients hospitalized in medical wards: a real life experience. Medicine, 99(7).

38. IX VII
X
II
Intrinsic pathway
(surface contact)
XII XIIa
XI
Tissue factor
IIa
Xa
XIa
IXa VIIa
VIII VIIIa
Extrinsic pathway
(tissue damage)
Xa
V Va
Fibrinogen Fibrin
Heparins and
LMWH2
Vitamin K antagonists3
Direct thrombin inhibitors4
Factor Xa inhibitors5
(Thrombin)
IIa
Targets for Anticoagulants
1Adapted with permission from
Petitou M, et al. Nature. 1991;350(suppl):30-33.
2Hirsh J, et al. Chest. 2001;119(suppl):64S-94S.
3Hirsh J, Fuster V. Circulation. 1994;89:1449-1468.
4Weitz JI, Hirsh J. Chest. 2001;119(suppl):95S-107S.
5Herbert JM, et al. Cardiovasc Drug Rev. 1997;15:1.

40. COMPARATIVE CHARACTERISTICS
OF ANTICOAGULANTS
Oral
administration
Fixed
dosing
Fast onset
and offset
Predictive
kinetics
No coagulation
monitoring
Warfarin
Dabigatran
Rivaroxaban











Heparin 
LMWH    

41. Thromboprophylaxis of Medically ill Patients : Clear
Benefits Over Placebo
MEDENOX1 63% 10 Placebo
Enoxaparin 40 mg
PREVENT2 49% 45 Placebo
Dalteparin
ARTEMIS3 47% 20 Placebo
Fondaparinux
Study RRR NNTProphylaxis Patients with VTE, %
P<0.001
P=0.0015
P=0.029
NNT = number needed to treat;
RRR = relative risk reduction.
RRR
63%
45%
47%
14.9* (n=288)
5.5 (n=291)
5.0 (n=1,473)†
2.8 (n=1,518)
10.5‡ (n=323)
5.6 (n=321)
*VTE at day 14; †VTE at day 21; ‡VTE at day 15.
Adapted from: 1Samama et al. N Engl J Med 1999;341:793-800.
2Leizorovicz et al. Circulation 2004;110:874-9.
3Cohen et al. Br Med J 2006.

42. RS Dr M Djamil Padang ( 2021 )

45. VTE prophylaxis for patients with cancer

46. VTE prophylaxis for patients with cancer
Conclusion:
• Changes to previous recommendations: Clinicians may offer thromboprophylaxis with
apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban
and edoxaban have been added as options for VTE treatment; patients with brain
metastases are now addressed in the VTE treatment section; and the recommendation
regarding long-term postoperative LMWH has been expanded.
• Re-affirmed recommendations: Most hospitalized patients with cancer and an acute
medical condition require thromboprophylaxis throughout hospitalization.
Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients
undergoing major cancer surgery should receive prophylaxis starting before surgery and
continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for
VTE risk, and oncology professionals should provide patient education about the signs and
symptoms of VTE

47. VTE prophylaxis for patients with cancer

48. VTE prophylaxis for patients with cancer

49. The Medenox Study Group
Prevention of
Venous Thromboembolism
in Medical Patients
The MEDENOX Study
N Engl J Med 1999;341:793-800
Conclusion:
Prophylactic treatment with 40 mg per day of enoxaparin
subcutaneously safely reduces the risk of venous thromboembolism in
patients with acute medical illnesses.

50. Treatment period Follow-up period
Eligible Patients:
- Age ≥ 40 years
- Immobilized for 3
days or less
- Medical Illness
(heart failure, acute
respiratory failure,
other conditions)
Day 1
Inclusion
Randomization
Day 6-14
Bilateral
venography
Day 83-110
End of
follow-up
Day -3 n
MEDENOX: Study Design
Randomized, double-masked, placebo controlled
Placebo
Enoxaparin 20 mg
Enoxaparin 40 mg
N Engl J Med 1999;341:793-800
n: 1,102

51. Samama MM et al. N Engl J Med 1999;341:793–800
P<0.001
0
2
4
6
8
10
12
14
16
All VTE Proximal DVT PE
Placebo
Enoxaparin 20 mg
Enoxaparin 40 mg
P=0.04
P=NS
14.9
5.5 4.9
15.0
4.5
RRR=63%
RRR=65%
Patients
(%)
1.7 1.0 0.3
0.0
Efficacy of LMWHs in Medical Patients
- MEDENOX Study -
RRR = Relative risk reduction

52. 0
5
10
15
Placebo Enoxaparin
20 mg
Enoxaparin
40 mg
Injection-site
haematoma
Minor haemorrhage
Major haemorrhage
NS
NS, not significant
Patients
(%)
Haemorrhagic Events During Treatment Period
No difference in risk of haemorrhage between groups
- MEDENOX Study -
n=27
(7.5%)
n=4
(1.1%)
n=4
(1.1%)
n=40
(11.4%)
n=39
(10.8%)
n=5
(1.4%)
n=6
(1.7%)
n=1
(0.3%)
Samama MM et al. N Engl J Med 1999;341:793–800

54. Frequency of VTE from day 1 to 14, in patient subgroups in the
MEDENOX study
Acute medical illness (n) Placebo (%) Enoxaparin 40 mg (%) RR (95% CI) P value
Heart Failure (290)
- NYHA class III (217)
- NYHA class IV (73)
14.6
12.3
21.7
4.0
5.1
0
0.29 (0.10 – 0.84)
0.42 (0.13 – 1.29)
-
0.02
0.2
0.05
Respiratory disease (457) 13.1 3.3 0.25 (0.10 – 0.65) 0.003
Infectious disease (463) 15.5 6.3 0.41 (0.20 – 0.82) 0.01
Rheumatic disease (78) 20.7 10.0 0.48 (0.11 – 2.16) 0.4
A subgroup analysis of the MEDENOX study also showed that
thromboprophylaxis with enoxaparin 40 mg once daily resulted in a significant
71% reduction of the risk of VTE among patients with heart failure (NYHA III or IV)
compared with placebo.
Alikhan R, et al.Blood Coagul Fibrinolysis.2003;14:341-6.

55. Ann Intern Med.2007;146:278-88
During anticoagulant prophylaxis, patients had a :
-significant reductions in any PE (RR, 0.43 [CI, 0.26 to 0.71];
-Significant reduction in fatal PE (RR, 0.38 [CI, 0.21 to 0.69];
-non-significant reduction in symptomatic deep venous thrombosis (RR, 0.47
[CI, 0.22 to 1.00]),
-non- significant increase in major bleeding (RR, 1.32 [CI, 0.73 to 2.37]).
-Anticoagulant prophylaxis had no effect on all-cause mortality (RR, 0.97 [CI,
0.79 to 1.19]).
CONCLUSION : Anticoagulant prophylaxis is effective in preventing
symptomatic venous thromboembolism during anticoagulant
prophylaxis in at-risk hospitalized medical patients
Annals Internal Medicine Review. 2007

57. ENOXAPARIN
 Enoxaparin is an anti-clotting agent.
 Enoxaparin is used for anti-clotting in
the treatment of DVT (deep vein
thrombosis), unstable angina, non-
STEMI and STEMI.
 Enoxaparin works to increase the
speed of inhibition of enzymes and
blood clotting factors.

58. Heparin VS Enoxaparin
• Heparin is an anticoagulant/blood thinner, also known as standard heparin
or unfractionated heparin (UFH). Heparin is administered intravenously or
subcutaneously.
• Enoxaparin is a low molecular weight heparin (LMWH). It is usually given
once or twice daily as a subcutaneous injection.

59. Heparin VS Enoxaparin

60. Heparin VS Enoxaparin
ACTION MECHANISM
Enoxaparin and heparin have a similar mechanism of action.
They work by binding to a small protein molecule called antithrombin
and blocking the action of thrombin, factor Xa, and other enzymes involved in
blood clotting.
Although Enoxaparin is classified as a low molecular weight heparin
(LMWH), it is not the same as standard heparin.

61. Heparin VS Enoxaparin

62. ENOXAPARIN LITERATURE
HEPARIN VS ENOXAPARIN
Conclusion:
Enoxaparin significantly reduces VTE in hospitalized medical patients,
compared with heparin, without increasing the risk of major bleeding, and
may reduce mortality.

63. ENOXAPARIN LITERATURE
EFFICACY and SAFETY
Conclusion:
The efficacy and safety of enoxaparin vs heparin for the treatment of DVT
is not altered by the presence of PE symptoms.

64. ENOXAPARIN LITERATURE
DOSE
Conclusion:
• A dose of 40 mg is the optimal dose for critically ill patients.
• Optimal effect is obtained up to a dose of 60 mg.

65. Do you have any questions?