Based upon criteria below, choose thrombotic risk
Risk of thrombosis while off anticoagulant can be estimated by indication for anticoagulant. Use the scheme below to identify thrombotic risk as low-to-moderate or as high. Indications are categorized as VT E, mechanical heart valve, a- fib, and thrombophilia.
VENOUS THROMBOEMBOLISM (DVT's & PEIs)
Low:
- VTE > 12 mos ago
Moderate:
- VTE 3-12 mos ago
- Recurrent VTE
High:
- Recent VTE (< 1 month or < 3 mos ago)
HEART VALVES
Low:
- Bileaflet mechanical aortic valve replacement without major risk factors for stroke*
Moderate:
- Bileaflet mechanical aortic valve replacement with major risk factors for stroke*
- Mitral valve replacement without major risk factors for stroke*
High
- Mechanical mitral valve
- Caged ball or tilting-disk valve
- Mechanical heart valve in any position with recent stroke or TIA (<3 mos ago)
* major risk factors for stroke: a-fib, multiple prior strokes/ TIA's not recent (23 mos ago), prior perioperative stroke, or prior valve thrombosis.
THROMBOPHILIA
Low: [none]
Moderate:
- Nonsevere coagulopathy (heterozyg factor V Leiden or prothrombin gene G20210A mutation)
- Active cancer
High
- Recent cardioembolic stroke (<3 mos ago)
- Active cancer associated with high VTE risk
- LV thrombus (within past 3 mos)
- Severe thrombophilia**
- Antiphospholipid antibodies
** severe thrombophilias: protein C defc, protein S defc, or antithrombin defc; homozyg factor V Leiden or prothrombin gene G20210A mutation or double heterozygous for each mutation, multiple thrombophilias
ATRIAL FIBRILLATION
Low:
- CHA2DS2-VASc score 1-4 (without prior history of stroke)
Moderate:
- CHA2DS2-VASc 5-6
High
- CHA2DS2-VASc 7 (or 5-6 with recent stroke or TIA)
- a-fib with rheumatic valvular heart disease