In a surgical patient with a history of coagulopathy, what is the most appropriate order for DVT/Bleeding prophylaxis?

In the context of a surgical patient with a history of coagulopathy, the priority for DVT and bleeding prophylaxis is to prevent thromboembolic events while also being mindful of the patient's bleeding risks. Pneumatic stockings, or compression devices, provide a mechanical method for promoting venous return and reducing the risk of deep vein thrombosis (DVT) without the added risk of altering coagulation status, making them particularly suitable for patients at risk of bleeding.

In patients with coagulopathy, initiating pharmacologic agents like heparin or Lovenox carries a risk of exacerbating bleeding complications. Coumadin, an oral anticoagulant, could similarly increase the risk of hemorrhage and is generally not used for acute prophylaxis in a surgical setting. Therefore, the use of pneumatic stockings acts as a safe and effective alternative for preventing DVT in this specific patient population while minimizing the risk of bleeding.