Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

In selecting a prophylactic anticoagulant dose for inpatients, the decision process involves evaluating three key medical conditions: history of adverse reaction to heparin, creatinine clearance over 30 mL/min, and weight exceeding 100 kg. Each condition has specific implications:

- A history of adverse reaction to heparin requires careful medication selection.
- Creatinine clearance above 30 mL/min indicates normal renal function, affecting anticoagulant choice.
- Weight over 100 kg may necessitate adjusted dosing for efficacy.

The anticoagulant regime is determined as follows:

- If a patient has had an adverse reaction to heparin and their creatinine clearance is above 30 mL/min, Fondaparinux 2.5 mg subcutaneously every 24 hours is recommended.
- In the case of a history of adverse reaction to heparin without sufficient creatinine clearance, consulting an expert is advisable.
- If creatinine clearance is maintained above 30 mL/min and the patient weighs over 100 kg, Dalteparin 7500 units subcutaneously every 24 hours is suitable.
- When only creatinine clearance is above 30 mL/min, Dalteparin 5000 units subcutaneously every 24 hours is the preferred option.
- For patients weighing more than 100 kg without sufficient creatinine clearance, Heparin 5000 units subcutaneously every 8 hours is recommended.
- In situations where none of the above conditions are met, the standard protocol is Heparin 5000 units subcutaneously every 12 hours.

This method ensures that the patient's unique medical profile guides the selection of a safe and effective prophylactic dose.

The calculator in question is the "Selection of Prophylactic Dose Anticoagulant for Inpatients" calculator. This tool is used in the clinical setting to determine the appropriate prophylactic dose of anticoagulant medication for hospitalized patients. The patient population it applies to includes inpatients who are at risk of developing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). 

The clinical utility of this calculator is to guide healthcare providers in selecting the correct prophylactic dose of anticoagulant, thereby reducing the risk of VTE in hospitalized patients. It takes into account various factors such as patient's age, weight, renal function, and risk factors for bleeding and VTE.

Exclusion criteria for its use may include patients with contraindications to anticoagulant therapy, such as active bleeding, history of heparin-induced thrombocytopenia, or severe renal impairment. It may also not be suitable for use in patients who are already on therapeutic anticoagulation or those with a low risk of VTE.

Selection of prophylactic dose anticoagulant for inpatients

Venous thromboembolism in pregnancy

Choice of anticoagulant therapy

General principles

Antepartum prophylaxis

Antepartum prophylaxis (primary prevention)

Patients with superficial venous thrombosis

Antepartum prophylaxis (secondary prevention)

Timing of delivery

Postpartum prophylaxis

Postpartum prophylaxis (secondary prevention)

Dosing of prophylactic low molecular weight heparin

Dosing of prophylactic LMWH

Evaluation for pulmonary embolism

Evaluation for PE

Catheter-directed thrombolysis

Postpartum prophylaxis (primary prevention)

Thrombolytic therapy

Setting of care

Patients who are breastfeeding

Patients undergoing assisted reproduction

Evaluation for deep vein thrombosis

Evaluation for DVT

Venous thromboembolism in pregnancy

Guidelines

Key sources