A separate page covers therapeutic anticoagulation.
An assessment of the requirement for thromboprophylaxis should be made on all patients at the time of admission.
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LOW RISK |
MEDIUM RISK |
HIGH RISK |
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Minor illness at any age |
Medical patients with any additional risk factor |
Acute illness causing lower limb paralysis |
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Early mobilisation |
s/c enoxaparin 20mg daily |
s/c enoxaparin 20mg* daily |
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ADDITIONAL PATIENT RISK FACTORS Patients with a history of DVT/PE/ thrombophilia move up one category |
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| Age >40 years | Heart failure |
| Pregnancy | Recent myocardial infarction |
| Immobility | Nephrotic syndrome |
| Malignancy (esp. pelvic, abdo, metastatic) | Inflammatory bowel disease |
| Severe infection | Polycythaemia |
| Marked obesity | Certain other conditions: eg Paroxysmal nocturnal haemoglobinuria, Behcet's disease, Homocystinaemia, Paraproteinaemia with hyperviscosity |
| Paralysis of lower limb(s) | |
| High dose oestrogens | |
Use enoxaparin with great caution (or not at all; or consider unfractionated heparin) in patients with acute renal failure or other condition that is not fully diagnosed or understood. This protocol recommends lower doses in high risk patients with renal impairment because of increased half life and possibly exacerbated effects in patients with renal failure. More information on anticoagulation in renal failure.
Thromboprophylaxis should be stopped 1 full day before renal biopsy (ie no dose within 24h).
Note that the risk of heparin may outweigh the benefits in some moderate and high risk patients
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Contraindications to enoxaparin |
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Within 12 hours of invasive procedures where there is a danger of significant bleeding complications eg epidural/spinal anaesthesia, or surgery |
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Active peptic ulceration, recent intracranial haemorrhage or other excessive risk from bleeding |
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Coagulopathies and thrombocytopenia |
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Severe liver disease |
Lorna Thompson and Paddy Gibson were the main authors for this page. It was updated in November 2006 by LT and ANT, and last amended
NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.