Risk of Deep Venous Thrombosis and Pulmonary Embolism in Surgical Patients

Calf

Proximal

PE

Fatal PE

Low

Nonmajor surgery* in patients < 40 years with no clinical risk factors

Early and aggressive ambulation

2

0.4

0.2

0.002

Moderate

Nonmajor surgery in patients with risk factors

Minor surgery in patients 40–60 years with no clinical risk factors

Major surgery in patients < 40 years with no other clinical risk factors

Immobilized patients with major medical illnesses

LDUH every 12 hours, LMWH, fondaparinux, or IPC, with or without elastic stockingsLDUH every 12 hours, LMWH, fondaparinux, or IPC, with or without elastic stockings

10–20

2–4

1–2

0.1–0.4

High

Nonmajor surgery in patients > 60 years or 40–60 years with risk factors

Major surgery in patients > 40 years or with other clinical risk factors

LDUH every 8 hours, LMWH, fondaparinux, or IPCLDUH every 8 hours, LMWH, fondaparinux, or IPC

20–40

4–8

2–4

0.4–1.0

Very high

Major surgery in patients > 40 years who have had a previous venous thromboembolic, malignant, or hypercoagulability disorder

In patients of any age:

• Hip or knee arthroplasty

• Hip fracture surgery

• Elective neurosurgery

• Multiple trauma

• Spinal cord injury

LMWH, oral anticoagulation, IPC, or elastic stockings plus either LDUH every 8 hours or LMWH

Fondaparinux if patients have had orthopedic, abdominal, or thoracic surgery or have an acute, severe illnessFondaparinux if patients have had orthopedic, abdominal, or thoracic surgery or have an acute, severe illness

LMWH or DOAC in some high-risk patients with cancer undergoing chemotherapy

40–80

10–20

4–10

0.2–5