Thromboprophylaxis

Thromboprophylaxis refers to measures designed to prevent the formation of blood clots in veins, with the goal of reducing venous thromboembolism, including deep vein thrombosis and pulmonary embolism. It is applied in medical and surgical settings when patients are at increased risk due to immobilization, major surgery, illness, pregnancy, cancer, or other factors, and may be used during hospitalization and, in selected cases, after discharge.

Strategies include pharmacologic means that inhibit clot formation and mechanical methods that improve venous return. Pharmacologic options commonly include unfractionated heparin and low-molecular-weight heparin, which are given by injection; fondaparinux is another injectable agent. Direct oral anticoagulants have been studied for perioperative prophylaxis in some populations, though their use varies by guideline and setting. The choice of agent, dose, and duration depends on the individual’s risk of thrombosis and risk of bleeding, as well as comorbid conditions and potential drug interactions.

Mechanical methods comprise graded pneumatic compression devices and properly fitted compression stockings. These are particularly useful when anticoagulation is contraindicated or as an adjunct in patients with elevated thrombotic risk.

Risk assessment guides prophylaxis decisions. Surgical patients are often evaluated with risk scores (for example, Caprini score), while medical and hospitalized patients may be assessed with other tools to determine the need for prophylaxis. Duration typically covers the hospital stay and may extend postoperatively for at-risk groups, such as those undergoing major orthopedic or cancer-related procedures.

Potential adverse effects include bleeding and, with heparin products, heparin-induced thrombocytopenia. Contraindications such as active bleeding or severe thrombocytopenia require careful assessment, and monitoring is used for certain agents.