Only 40% of ambulatory ED patients with PE have concomitant DVT
Chemical Prophylaxis of VTE
- Lovenox 30mg SubQ q12 hrs (if Cr Clearance > 30)
- Check Anti-Xa level every week EXACTLY 4 hours after 3rd dose of lovenox
- prophylactic goal: 0.2-0.6
- therapeutic goal: 0.6-1.2
- Recheck AntiXa level after each 3rd dose if dose is changed until you are at goal
- Recheck level every week (usually qMonday) for all patients
- If renal dysfunction order heparin 5000 Units SubQ q8 hrs (search “SURG DVT/VTE prophylaxis” order set)
- ↑ Righini M, Le GG, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008; 371(9621):1343-1352.
- ↑ Daniel KR, Jackson RE, Kline JA. Utility of the lower extremity venous ultrasound in the diagnosis and exclusion of pulmonary embolism in outpatients. Ann Emerg Med. 2000; 35(6):547-554.