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Level 1 Trauma

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Quick reference algorithm

VTE Prophylaxis Decision Tree

Trauma / orthopedic patients age ≥ 15 · March 2026 edition

If multiple injuries, use most conservative timingEnoxaparin: round DOWN to nearest 10 mg

Trauma / Ortho Admission — Age ≥ 15

Step 1

SCDs ON Immediately

Active bleeding OR absolute contraindication?

YESMechanical only ↓NODetermine timing ↓

YES

Mechanical prophylaxis only

SCDs + reassess q12h

↻ Reassess for chemical prophylaxis eligibility ↑

Stops here — does not continue to Step 2

NO

Determine timing

Step 2

Determine Timing by Injury

Injury Category?If multiple, use most conservative timing

TBI — BIG 1–2
Start within 24h
Standard dose
TBI — BIG 3
Start 24–72h
Reduced dose × 72h
Solid Organ I–III
Start within 24h
Solid Organ IV–V
Start 24–48h
When hemodynamically stable with stable H/H

SCI
Start within 48h
Pelvic / Long Bone Fx
Within 24h post-op
Hip Fracture
6–12h post-op

Step 3

Weight-Based Enoxaparin Dose

0.5 mg/kg SC q12h — Round DOWN to nearest 10 mg

40–59 kg: 20 mg q12h
60–79 kg: 30 mg q12h
80–99 kg: 40 mg q12h
100–119 kg: 50 mg q12h
120–139 kg: 60 mg q12h
≥ 140 kg: 70 mg q12h

High-risk for monitoring?

YESHigh-risk ↓NOContinue ↓

YES

High-risk

High-Risk Criteria

BMI ≥ 40
Weight > 100 kg
CrCl 15–29 mL/min
TBI / SCI on reduced dose

Order Anti-Xa Level

4h after 3rd dose

Target: 0.2–0.4 IU/mL

NO

Continue

Continue

Weight-based dosing

Step 4

Discharge Planning

Check Duration Table for extended prophylaxis indications

Sources

VTE Prophylaxis Decision Tree, Trauma / Orthopedic Patients — v1.0, March 2026. For institutional use only.
Based on EAST Guidelines, ACS TQIP Best Practices, and BIG Classification.

Clinical decision support only — not a substitute for clinical judgment.