| I. Lifestyle modifications |
| A. Avoid obesity and inactivity |
| i. Nutrition without excess calories |
| ii. Exercise |
| 1. Daily aerobic such as walking |
| 2. Anaerobic activity useful for muscle toning |
| a. Heavy weightlifting may traumatize muscles |
| b. Anaerobic does not substitute for aerobic |
| B. Avoid dehydration |
| i. Drink water |
| ii. Minimize alcohol consumption |
| C. Avoid cigarette smoking |
| i. Quit smoking |
| 1. Willpower is best |
| 2. Nicotine patch, gum, nasal spray |
| 3. Bupropion (Wellbutrin [GlaxoSmithKline]) |
| D. Maintain normal blood pressure |
| i. Note some guidelines define normal as <120/80 mm Hg rather than <140/90 mm Hg |
| ii. If lifestyle changes do not reduce blood pressure, use medication |
| II. Mechanical measures |
| A. Vascular compression stockings |
| i. 10 to 18 mm Hg if immobilized or in bed; otherwise, use higher compression levels |
| ii. 20 to 30 mm Hg below-knee stockings if no varicose veins, swelling, or skin pigmentation changes |
| iii. 30 to 40 mm Hg below-knee stockings if leg exam has evidence of prior venous disease |
| B. Intermittent pneumatic compression boots |
| i. Ideal for immobilized patients, either in hospital, skilled nursing facility, or at home |
| ii. Device is better tolerated when combined with 10- to 18-mm Hg vascular compression stockings |
| iii. Some devices have "cooling buttons" to enhance comfort |
| III. Pharmacological measures |
| A. Injectable medications |
| i. Low-molecular-weight heparin |
| 1. Enoxaparin 40 mg daily |
| 2. Dalteparin 5000 Units daily |
| ii. Unfractionated heparin 5000 Units every 8 hours |
| iii. Fondaparinux 2.5 mg daily |
| B. Oral medication |
| i. Warfarin |
| C. Baby aspirin 81 mg daily |
| i. Provides more protection against heart attack and stroke than against DVT |
| ii. DVT prevention effect is weak |
| IV. Combined mechanical and pharmacological measures |
