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VTE Prophylaxis for Medical Inpatients: Algorithm and Order Set

This algorithm and order set provides guidance on VTE prophylaxis for medical inpatients, taking into account major risk factors and contraindications. It includes recommendations for mechanical prophylaxis, systemic anticoagulation, and documentation of risk assessment.

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VTE Prophylaxis for Medical Inpatients: Algorithm and Order Set

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  1. Algorithm driving ‘smart’ order set at Hopkins in Medical inpatientsZeidan AM, et al. Am J Hematol. 2013; 88:545-549

  2. Major Risk Factors • Age > 60 • Cancer • Previous VTE • Acute CVA w/ paresis (< 3 mos.) • Thrombophilia • Decompensated NYHA Class III/IV heart failure • Respiratory failure (ventilator-dependent) • Acute infection/sepsis • Pregnancy/post-partum Key Contraindications • High risk of bleeding • Active bleeding • Systemic anticoagulation • INR ≥ 1.5 or aPTT ratio ≥ 1.3 • Platelet count < 50,000

  3. TEDs/SCDs Use mechanical prophylaxis until contraindication no longer • present. Review patient status daily • (0,2) General Medicine VTE Scheme Yes (2) High Risk w/ Contraindications • TEDs/SCDs Use mechanical prophylaxis until contraindication no longer • present. Review patient status daily • (0,3) Yes (3) *Contraindications Yes (0) High Risk W/ Systemic Anticoagulation No (1) • Heparin 5000 units sc q8h • (0,1) *Major VTE Risk Factor High Risk w/o contraindications No (6) Yes (2) *Contraindications • TEDs/SCDs Use mechanical prophylaxis until contraindication no longer • present. Review patient status daily • (6,2) No (1) Yes (3) Mod Risk w/ Contraindications • Heparin 5000 units sc q12h • Consider adding TED/SCDs • (6,1) • TEDs/SCDs Use mechanical prophylaxis until contraindication no longer • present. Review patient status daily • (6,3) Mod Risk w/o contraindications Mod Risk W/ Systemic Anticoagulation

  4. Parent order set

  5. Any Attempt to uncheck the order will give this message

  6. Patient age, weight, renal function and relevant labs imported from database

  7. Mandatory Selections • Risk Factors • Contraindications

  8. Prophylaxis Recommendation

  9. Documentation of Risk Assessment

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