Preventing VTE: A guide to nonpharmacologic therapies: An update on which approaches are effective - And for whom

Preventive measures are recommended for all patients at risk for venous thromboembolism. When they cannot be given adequate prophylaxis with low molecular weight heparin (the current gold standard) or another anticoagulant, consider nonpharmacologic methods. The ones most commonly used-graduated compression stockings and pneumatic devices that apply intermittent pressure to the calf, leg, or plantar surface of the foot-are effective in preventing deep venous thrombosis (DVT) in immobilized patients (for example, those in the ICU) and patients undergoing various surgical procedures. These devices often confer an increased benefit when used in combination or (in select patients) with low-dose heparin. If the patient has risk factors for preexisting DVT (such as hospitalization for more than 72 hours), consider screening the legs for thrombus before initiating mechanical prophylaxis.