07/16/2013    Zeeshan Husain, DPM

DVT Protocol (Tip Sullivan, DPM)

Here is the form that two of my local hospital
systems use for DVT prophylaxis (summary below).
Surgeons are required to complete and nurses are
completing in the electronic chart pre-
operatively for us to review and approve. The
guidelines are based on the recommendations from
the following articles:
Geerts, et al., Chest 133:381S-453S, 2008.
Seruya, et al., Plastics and Reconstructive
Surgery 122(6):17 01-08, 2008.
Hatel, et al., Plastics and Reconstructive
Surgery 122(1): 269-79, 2008.

Risk Factors (Points)
5- Total hip or knee replacement
5- Hip, pelvis, spine, or leg fracture (<1mo)
5- History of stroke (<1mo)
5- Multiple trauma (<1mo)
4- Undergoing adbominoplasty
3- History of DVT/PE
3- Age >75yrs
3- Inherited hypercoaguable state
3- History of MI, CHF, sepsis, serious lung
disease, pneumonia
3- Malignancy (except skin)
3- Obesity (BMI= >50)
2- Obesity (BMI 40-49)
2- Age 61-75yrs
2- Nephrotic syndrome
2- Immobilizing cast (<1mo)
2- Confined to bed (>24hrs)
2- Surgery (anesthesia >60min)
1- Surgery (anesthesia <=60min)
1- Age 41-60yrs
1- History of prior major surgery (<1mo)
1- Inflammatory bowel disease
1- Central venous access (<1mo)
1- Obesity (BMI 30-39)
1- Oral contraceptive, hormone replacement
therapy, selective estrogen receptor modulators
1- Pregnancy or post-partum <1mo
1- Significant varicose veins or >+1 swollen legs

Recommendations based on total points
2- moderate risk: heparin +/- compression
stockings
3-4- high risk: heparin +/- compression stockings
5+- highest risk: enoxaparin, heparin, or warfarin

The form evaluates the patient for risk factors
and then there are recommendations based on how
many risk factors are noted. In non-immobilizing
procedures, you may disagree with the
recommendations and state your reason for doing
so.

The form was created by the hospital attorneys to
try to shield the hosptials and place more
responsibility on the surgeon.

Zeeshan Husain, DPM, Rochester, MI,
ZEE@ALUM.MIT.EDU

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