(28,34,35,36,37) Six randomized double-blind controlled clinical trials demonstrated reduced risk of total and proximal DVT by at least 50% for patients with total hip replacement who received prophylaxis with either LDUH or LMWH for 5 weeks beyond the hospital stay.
(29) For this reason, heparin therapy (LDUH or LMWH) usually overlaps warfarin therapy for at least the first 2 days of oral anticoagulant therapy to allow for the warfarin to take effect and to achieve an optimal therapeutic range of anticoagulation.
Moderate-risk and moderately high-risk general surgery patients should receive prophylaxis with LDUH or LMWH; high-risk patients warrant a combination of mechanical and anticoagulant prophylaxis.
Mechanical prophylaxis is warranted in patients at high risk of bleeding; otherwise LDUH or LMWH is recommended for moderate-risk patients, and LMWH is recommended for high-risk patients.
Patients who require surgery for hip fracture should receive anticoagulant prophylaxis with fondaparinux, LMWH, LDUH, or adjusted-dose vitamin K antagonist (target INR 2.5).
Patients undergoing major gynecologic or open urologic procedures should receive prophylaxis with LDUH administered b.i.d.
Burn patients with any additional risk factors for thromboembolism should be given prophylaxis with LDUH or LMWH as soon as the physician considers it safe.
patterns loadg is ldsb | ldsh | ldub | lduh
| id | ldstub | swap constructors
* LDUH, LMWH, or IPC for higher-risk general surgery
* Twice-daily LDUH for major gynecological surgery for benign disease
* Three-times-daily dose LDUH for gynecological surgery for malignancy
* IPC with GCS for intracranial surgery; LDUH or postoperative LMWH are acceptable alternatives