Dvt prophlaxis

1. DVT prophylaxis

2. Mechanical prophylaxis
▪ Graduated compression stockings
▪ Intermittent pneumatic compression

3. Graduated compression stockings
▪ GCS apply pressure on the leg
muscles to squeeze the vein
valves starting with the greatest
degree of compression at the
ankle and decreasing the level of
compression up the leg. This
helps ensure that blood flows
upwards to the heart instead of
refluxing downwards.

4. Intermittent pneumatic compression
IPC includes sleeves/cuffs applied to legs
and garments wrapped around the foot (foot
impulse devices) connected to an air pump
that sequentially inflates to improve venous
circulation in the limbs.
IPC is more effective than GCS in preventing
DVT in surgical patients. IPC is
recommended over GCS in patients with
moderate to high risk that are not receiving
pharmacological prophylaxis or in patients
at very high risk that are on combined
mechanical and pharmacological
prophylaxis.

5. Pharmacological prophylaxis
▪ Heparin(LMWH,UFH)
▪ Vit.K antagonist (warfarin)
▪ Factor Xa Inhibitors
▪ Anti-platelet agents

6. Heparin
Unfractionated heparin(UFH) : is a fast-acting blood thinner that works together
with antithrombin, a natural protein in the body, to block clot formation.
Specifically, UFH binds to antithrombin and enhances its ability to inhibit two of
the body’s most potent clotting factors – factor Xa and factor IIa – usually
within minutes.
Option for patients with renal impairment and patients at increased
risk of bleeding
LMWHs:Preferred option except in patients with renal impairment or
patients at increased risk of bleeding

7. Vit.K antagonist
Warfarin:Warfarin is a [vitamin K] antagonist which
acts to inhibit the production of vitamin K dependent
clotting factors (factors II, VII , IX , and X)
•Slow in onset
• Monitoring INR is required (INR range of 2.0 to
3.0)
Warfarin is indicated as a prophylaxis of DVT after
THR and TKR
Initial dose: 2 to 5 mg orally once a day
Maintenance dose: 2 to 10 mg orally once a day

8. Factor Xa Inhibitors
Factor Xa inhibitors are a type of anticoagulant
that work by selectively and reversibly blocking the
activity of clotting factor Xa, preventing clot
formation. They affect both factor Xa within the
blood and within a preexisting clot. They do not
affect platelet aggregation.
Apixaban: Dosing for DVT prophylaxis following hip
or knee replacement surgery: Oral, 2.5 mg, twice-
daily.
Rivaroxaban: Dosing for DVT prophylaxis following
hip or knee replacement surgery: Oral, 10 mg,
once-daily for 35 days (hip replacement surgery);
oral, 10 mg, once-daily for 12 days (knee
replacement surgery)

9. Anti-platelet agents
Aspirin: works by irreversibly inhibiting the
enzyme cyclo-oxygenase (COX-1) which is
required to make the precursors of
thromboxane within platelets. This reduces
thromboxane synthesis. Thromboxane is
required to facilitate platelet aggregation and
to stimulate further platelet activation.
The national VTE Prevention Clinical Care
Standard includes aspirin “for use in hip and
knee replacement surgery only, usually in
combination with mechanical methods and in
patients without major risk factors for VTE and
bleeding
• Dosage : 75 mg OD