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● Pharmacoprophylaxis is indicated in patients with medium or high VTE risk and normal bleeding risk.
● Due to good controllability (short half-life, antagonisation with protamine) and therapy adherence (injections) low molecular weight heparins are drugs of choice. Products with larger molecules such as dalteparin are safer due to lower risk of accumulation during renal impairment. Patients with heparin-induced thrombocytopenia (HIT) history should receive argatroban.
● The intensity of anticoagulation depends on the individual VTE risk and - in interventional patients - also on the bleeding risk.
● In interventional patients the therapy is interrupted for a peri-operative period of 12-24 h and then resumed and continued until full mobilization and up to 5 weeks after certain, mostly orthopedic, procedures.
● In discharged patients with expected high therapy adherence VTE prophylaxis can be continued with one of the new oral anticoagulants (NOAC, e.g. rivaroxaban). Older oral anticoagulants such as warfarin and phenprocoumon are not economical for short post-discharge treatments due to the laborious dosage determination.