What is your approach to VTE prophylaxis in hospitalized patients who are already on DAPT?
Particularly with prolonged hospitalizations, do you have any concerns about exposing patients to bleeding risks associated with "triple therapy" even though dosing for the anticoagulant is prophylactic?
1 Answer
Mednet MemberInvited Expert
Hospital Medicine · University of California, San Francisco
Answered on
DAPT by itself is not considered DVT prophylaxis in patients at high risk of DVT. However, LMWH at prophylactic doses can increase the need for transfusions in patients on DAPT, without decreasing VTE rates. In general, I consider patients individually:
- Do they still need DAPT? With discontinuity of care, a lot of patients remain on it even after they could stop it.
- Are they at high risk of VTE? (prior VTE, malignancy)?
- Are they at risk of significant bleeding (severe thrombocytopenia, major bleeding in the past, recent surgery, etc.)?
This helps me assess the risk/benefit to the patient. For example, in general, the benefit of VTE prophylaxis is higher in surgical patients than in medical patients, given higher rates of VTE in that group...
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