Appendix B: Sample Venous Thromboembolism Protocol/Order Set
University of California, San Diego Medical Center VTE Risk Assessment and Prophylaxis Orders
(paper version of computerized order set)
|Low Risk||Moderate Risk||High Risk|
Ambulatory patient without additional VTE risk factors or expected length of stay <2 days.
* Early ambulation.
Patients who aren't in either the low- or high-risk group (go to VTE risk factor table)
Select one pharmacologic* option:
Sequential compression device aka SCDs (Optional for these patients if they are on pharmacologic prophylaxis, mandatory if not).
Elective hip or knee arthroplasty.
Select one pharmacologic # option:
* Go to Contraindications table.
# Enoxaparin should only be used in patients with CrCl>30 and SCr<2; do not use if epidural/spinal catheter is in place.
SCDs should be used in all patients for whom pharmacologic prophylaxis is contraindicated and in all high-risk patients unless patient is intolerant or with contraindications to SCDs.
Note: Enoxaparin is the USCD Medical Center formulary low molecular weight heparin (LMWH); other LMWHs are considered equivalent.
Venous Thromboembolism Risk Factors
|Age >50 years
Congestive heart failure
Moderate to major surgery
|Prior history of VTE
Inflammatory bowel disease
Active rheumatic disease
Sickle cell disease
Central venous catheter
|Acute or chronic lung disease
Known thrombophilic state
Varicose veins/chronic stasis
Recent post-partum with
Contraindications or Other Conditions to Consider With Pharmacologic VTE Prophylaxis
** Scheduled return to OR within the next 24 hours: major ortho: 24 hours leeway; spinal cord or ortho spine: 7 days leeway; general surgery, status post transplant, status post trauma admission: 48 hours leeway.