Table 1.
Thromboprophylaxis agents
| Agent class | Examples | Comments |
|---|---|---|
| Low-molecular-weight heparin | Enoxaparin | – Subcutaneous daily administration |
| Dalteparin | – Dose adjustment is necessary for renal impairment and weight | |
| Tinzaparin | ||
| Unfractionated heparin | – Subcutaneous twice or thrice daily administration | |
| – May not be available in the outpatient setting | ||
| – No adjustment needed for renal impairment | ||
| Factor Xa inhibitor | Fondaparinux | – Subcutaneous daily administration |
| – Sometimes used in patients with heparin induced thrombocytopenia | ||
| – Contraindicated in severe renal impairment | ||
| Direct anticoagulants | Rivaroxaban | – Oral administration |
| Dabigatran | – Rivaroxaban is approved for acutely ill hospitalized medical patients and for orthopedic patients (knee and hip replacement)a | |
| Apixaban | – Dabigatran is approved for hip replacement and apixaban for knee and hip replacementa | |
| – Not used in severe renal impairment | ||
| – Levoketoconazole increases levels of dabigatran (avoid combination) [27] | ||
| – Ketoconazole increases levels of rivaroxaban (avoid combination), dabigatran, and apixaban (consider therapy modification) [28] | ||
| Acetyl salicylic acid | Aspirin | – Very rarely used in nonorthopedic patients |
| – May be used if other agents are contraindicated or not available | ||
| – Consider concomitant use of gastrointestinal prophylaxis with a proton-pump inhibitor | ||
| Warfarin | – Very rarely used for routine thromboprophylaxis; concurrent use of ketoconazole results in increased level of warfarin [28] |
Mechanical prophylaxis using intermittent pneumatic compression or elastic stockings in addition to pharmacologic agents for higher-risk patients.
a Food and Drug Administration–approved indications.