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Venous Thromboembolism (VTE) Prevention — Contraindications to Anticoagulation — Clinical Pathway: Inpatient

Venous Thromboembolism (VTE) Prevention Clinical Pathway — Inpatient

Contraindications

Contraindications to Mechanical Prophylaxis
  • Peripheral IV access in lower extremity
  • Suspected or existing deep vein thrombosis
  • Finding of thrombosis
  • Skin conditions affecting extremity
    • Dermatitis
    • Burns
  • Acute fracture
    • Use device on unaffected extremity
  • No appropriate size pneumatic sequential compression device (SCD) available
  • Lower extremity conditions which result in significant pain with compression
    • Solid tumor
    • Vaso-occlusive episode in sickle cell disease
  • Surgical or anesthesia contraindication to sequential compression during a procedure
  • Concern that SCDs could be used to harm self or medical team
Contraindications to Anticoagulation
  • Ongoing, uncontrolled bleeding
    Congenital bleeding disorder
    Uncorrected coagulopathy
  • Intracranial hemorrhage, mass
    Acute stroke/brain ischemia
    Incomplete spinal cord injury with suspected or known paraspinal hematoma
  • Uncontrolled severe hypertension
  • Allergy to unfractionated heparin (UFH) or enoxaparin
    • Heparin-induced thrombocytopenia
    Platelet count < 50,000/µL
  • Likely to require an invasive procedure within 24 hrs of starting enoxaparin
  • Epidural — discuss with Anesthesia prior to initiating pharmacologic prophylaxis

 

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