Every trauma patient should receive pharmacologic DVT prophylaxis, following the weight-based Lovenox guidelines (see slides), with the following exceptions:
- Intracranial hemorrhage:
- Start pharmacologic DVT prophylaxis 24-72 hours AFTER stable head CT with specific timing at neurosurgery attending discretion
- Patients with intracranial hemorrhage receive 30mg lovenox BID, they do not receive weight-based prophylaxis.
- Hemorrhagic shock or solid organ injury: Start when bleeding controlled and H&H stable, generally ~24 hours after admission
- Hold for 12 hours before procedures where a small amount of bleeding can cause a big problem
- Intracranial procedure
- Spine procedure
- Ophthalmology procedure
- If any other hold on DVT prophylaxis is requested, it should be discussed with trauma fellow or attending before being carried out
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