Deep vein thrombosis prophylaxis ? Critically ill patients are generally immobile. All mechanically ventilated patients, those with cancer, CHF, CVA and all bed-bound patients should receive prophylaxis for deep vein thrombosis (subcutaneous unfractionated heparin 5000 U BID is standard of care; pneumatic compression boots can be used for patients with heparin-induced thrombocytopenia, significant active bleeding or CNS hemorrhage).

Summary and recommendations

• Acute MI: We recommend that most patients with acute MI receive prophylactic or therapeutic anticoagulant therapy with SC LDUH or IV heparin (grade 1A).
• Ischemic Stroke: For patients with ischemic stroke and impaired mobility, we recommend the routine use of LDUH, LMWH, or the heparinoid, danaparoid (all grade 1A).

  If anticoagulant prophylaxis is contraindicated, we recommend mechanical prophylaxis with ES or IPC (grade 1C+).

• Other Medical Conditions: In general medical patients with risk factors for VTE (including cancer, bedrest, heart failure, severe lung disease), we recommend LDUH or LWMH (grade 1A).