Approach to VTE prophylaxis

Involve the patient when choosing venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE]) prophylaxis. For a VTE prophylaxis consumer fact sheet, see the Australian Commission on Safety and Quality in Health Care (ACSQHC) website.

Pharmacological prophylaxis is preferred for most patients at risk of developing VTE because it is more effective than mechanical prophylaxis. Parenteral anticoagulants or direct-acting oral anticoagulants (DOACs) are first-line options for VTE prophylaxis, with choice dependant on the patient and the indication; aspirin has limited data to support its use. For suitable options for VTE prophylaxis for patients with known or suspected heparin-induced thrombocytopenia, see Heparin-induced thrombocytopenia.

The indications for and the duration of anticoagulant therapy for VTE prophylaxis for nonsurgical patients are discussed in VTE prophylaxis for nonsurgical patients; for surgical patients, see VTE prophylaxis for surgical patients. Continue therapy until the patient is no longer at increased risk of VTE.

The recommendations for VTE prophylaxis in this topic mainly relate to patients who are in hospital. However, prolonged immobility in other situations (eg long-distance travel or acute lower-limb injury) can increase the risk of developing VTE, particularly if the patient has other factors increasing risk.

Specific considerations apply to VTE prophylaxis during pregnancy and the postpartum period and VTE prophylaxis for patients with active cancer.

For patients with palliative care needs, continuation of VTE prophylaxis is generally not required in the last weeks of life because the bleeding risk from prophylaxis may outweigh the benefits. It is reasonable to stop anticoagulant therapy in the last days of life. See Rationalising anticoagulants in palliative care in the Palliative care guidelines for more information.