DVT prophylaxis in bedridden residents of nursing homes

Dr Susan Kahn is a professor in the Department of Medicine at McGill University, codirector of the Canadian Venous Thromboembolism Research Network (CanVECTOR), and founder of the McGill Thrombosis Fellowship.

What deep vein thrombosis (DVT) prophylaxis should be used in an older bedridden patient in a long-term care facility? What do you think about heparin or compression stockings in such settings?

Susan Kahn, MD, MSc: Although venous thromboembolism (VTE) prophylaxis has been recommended by the recent American Society of Hematology (ASH) guideline panel for use in hospitalized medically ill patients, we do not make such a recommendation for out-of-hospital chronically ill patients who are living in nursing homes. This is mostly because it is thought that those patients, who are fairly medically stable, do not have a particularly elevated risk of VTE and it is likely that the harms of prophylaxis would outweigh any benefit.

So on a population-wide scale, we do not recommend that those chronically ill patients receive prophylaxis.