Other Options for Preventing Venous Thromboembolism

This section details the other options for thromboprophylaxis, including antiplatelet agents and mechanical prophylaxis

Other options for VTE prevention

Antiplatelet agents

Although ASA (aspirin) is more effective than placebo in preventing VTE in high-risk patients, it is less effective than LMWH. There are insufficient data comparing ASA with warfarin or UFH for VTE prophylaxis, and there are currently no comparative studies with the NOACs. The 2012 American College of Chest Physicians (ACCP) guidelines recommend ASA, among other antithrombotics, over no prophylaxis at all, but LMWH or oral anticoagulants are preferred.

Mechanical prophylaxis

Mechanical prophylaxis methods do reduce the risk of DVT, although they have not been studied as intensively as pharmacological options:

  • Mechanical methods of prophylaxis include elastic compression stockings and various intermittent compression devices, all of which increase venous outflow or reduce blood stasis within the leg veins
  • Elastic compression stockings have been shown to effectively reduce symptomatic DVT; however, their use is also associated with an increase in skin complications
  • Mechanical prophylaxis should be used primarily in patients who are at high risk of bleeding or as an adjunct to anticoagulant therapy
Summary of mechanical prophylaxis methods
Method Function Supporting data
Elastic (graduated) compression stockings Provide circumferential pressure that gradually decreases from the ankle to the thigh to promote venous blood flow Studies in hip surgery, general surgery and stroke
Intermittent pneumatic compression Leggings repeatedly inflated and deflated by a pneumatic pump with the goal of mimicking natural calf muscle contractions that promote venous return Meta-analysis of published studies
Venous foot pump Imitates the physiological pumping action of weight bearing on the venous plexus of the sole of the foot to simulate the effect of normal walking and increase venous flow Limited

Investigational strategies

The oral, direct Factor Xa inhibitor betrixaban has been investigated for the prevention of VTE after orthopaedic surgery. The phase II EXPERT study randomized patients undergoing elective total knee replacement surgery to receive betrixaban 15 mg or 40 mg twice daily, or enoxaparin 30 mg twice daily, for 10–14 days after surgery. The incidence of VTE was 20% with betrixaban 15 mg twice daily, 15% with betrixaban 40 mg twice daily and 10% with enoxaparin 30 mg twice daily. There were no bleeding events with betrixaban 15 mg twice daily and 2.4% of patients had non-major clinically relevant bleeding with betrixaban 40 mg twice daily. However, no phase III study of betrixaban in orthopaedic surgery is currently underway.

Medically ill patients are at a high risk of venous thromboembolic events during their hospital stay, and this risk extends into the period after discharge from hospital.

Learn more about ongoing studies in acutely ill medical patients and other special patient populations here.

Next section: Treatment of Deep Vein Thrombosis and Pulmonary Embolism

Approval No.: G.MKT.GM.XA.08.2016.1052

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