Table 13

Levels of Thromboembolism Risk in Surgical Patients Without Prophylaxis

Level of RiskDeep Vein Thrombosis, %Pulmonary Embolism, %Successful Prevention Strategies
CalfProximalClinical EventsFatal Events
  • Low

  •  Minor surgery in patients less than 40 years old with no additional risk factors

20.40.2Less than 0.01No specific prophylaxis; early and “aggressive” mobilization
  • Moderate

  •  Minor surgery in patients with additional risk factors

  •  Surgery in patients aged 40 to 60 years with no additional risk factors

10 to 202 to 41 to 20.1 to 0.4LDUH (every 12 h), LMWH (less than or equal to 3400 U daily), GCS, or IPC
  • High

  •  Surgery in patients more than 60 years old or aged 40 to 60 years with additional risk factors (prior VTE, cancer, molecular hypercoagulability)

20 to 404 to 82 to 40.4 to 1.0LDUH (every 8 h), LMWH (more than 3400 U daily), or IPC
  • Highest

  •  Surgery in patients with multiple risk factors (age greater than 40 years, cancer, prior VTE)

  •  Hip or knee arthroplasty, HFS

  •  Major trauma; SCI

40 to 8010 to 204 to 100.2 to 5.0LMWH (more than 3400 U daily), fondaparinux, oral VKAs (INR 2 to 3), or IPC/GCS plus LDUH/LMWH

Adapted with permission from Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:338S–400S (112).

GCS indicates graduated compression stocking; HFS, hip fracture surgery; INR, international normalized ratio; IPC, intermittent pneumatic compression; LDUH, low-dose unfractionated heparin; LMWH, low-molecular-weight heparin; SCI, spinal cord injury; U, unit; VKA, vitamin K antagonist; and VTE, venous thromboembolism.