SSC 2012 Guidelines

Prophylaxis for Venous

Thromboembolism (VTE)
C. Deutschman

Copyright 2014 SCCM/ESICM

Prophylaxis for VTE

Key Initial Findings and Preliminary
Reasoning

There are no primary data on the incidence of

VTE in septic patients.
ICU patients are at high risk for VTE.
Risk factors in patients with severe sepsis or
septic shock are the same or more
pronounced.
The incidence in septic patients should the
same or higher.
VTE prevention in septic patients is desirable.
Pulmonary embolism (PE) is likely to have
dire consequences in hemodynamically
unstable patients.
Slide 2
Copyright 2014 SCCM/ESICM

Prophylaxis for VTE

We recommend that patients with severe
sepsis receive daily pharmacoprophylaxis
against VTE (Grade 1B).

Slide 3
Copyright 2014 SCCM/ESICM

Prophylaxis for VTE

We recommend daily subcutaneous lowmolecular weight heparin (LMWH) for VTE
prophylaxis.
Grade 1B versus unfractionated heparin
(UFH) twice daily
Grade 2C versus UFH given thrice daily

Slide 4
Copyright 2014 SCCM/ESICM

Prophylaxis for VTE

If creatinine clearance is <30 mL/min, we
recommend use of dalteparin (Grade 1A)
or another form of LMWH that has a low
degree of renal metabolism (Grade 2C)
or UFH (Grade 1A).

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Copyright 2014 SCCM/ESICM

Prophylaxis for VTE

We suggest that patients with severe sepsis
be treated with a combination of
pharmacologic therapy and intermittent
pneumatic compression devices whenever
possible (Grade 2C).

Slide 6
Copyright 2014 SCCM/ESICM

Prophylaxis for VTE

We recommend that septic patients who
have a contraindication to heparin not
receive pharmacoprophylaxis (Grade 1B).
Rather, we suggest they receive mechanical
prophylactic treatment, such as graduated
compression stockings or intermittent
compression devices, unless
contraindicated (Grade 2C).
When the risk decreases, we suggest
starting pharmacoprophylaxis (Grade 2C).
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Copyright 2014 SCCM/ESICM