Perioperative thromboprophylaxis in the critically ill – European Guideline 2107

European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care (November 2017)

Recommendations for critically ill patients (minor abridgements):
  • don’t routinely use of compression DUS (Duplex ultrasound) screening of DVT (Grade 1B).
  • do use a protocol for the prevention of VTE that includes the use of mechanical Thromboprophylaxis (IPC) (1B).
  • do use thromboprophylaxis with LMWH or LDUH (1B) and (recommend LMWH over LDUH) (1B).
  • in severe renal insufficiency, use LDUH (2C), dalteparin (2B) or reduced-dose enoxaparin (2C). Consider monitoring anti-Xa activity (2C).
  • pharmacological prophylaxis in patients with severe liver dysfunction needs balancing against bleeding risk. If administered, use LDUH or LMWH (2C).
  • do use prophylaxis or the use of IPC in patients with a platelet count less than 50 000mm3 and a high risk of bleeding (2C).
  • don’t routinely use IVC filters (IVCFs) for the primary prevention of VTE (1C).
  • consider IVCF in patients who can neither receive pharmacological prophylaxis nor IPC (2C).
  • in suspected or confirmed diagnosis of heparin-induced thrombocytopenia (HIT),
    1. discontinue all forms of heparin (1B).
    2. use immediate anticoagulation with a non-heparin anticoagulant unless there is a strong contraindication to anticoagulation (1C).
  • selection of non-heparin anticoagulants should be based on patient characteristics:
    • argatroban is the first choice in patients with renal insufficiency
    • bivalirudin in patients undergoing or after cardiac surgery (2C)
    • fondaparinux can also be considered (2C).