Age (in Years)

Sex Male Female

Race African American Non-African American

Serum Creatinine (in mg/dl):

Serum BUN (in mg/dl):

Serum Albumin (in g/dl):

Hemoglobin Level (in g/dl)?

Any History of Hemorrhage? Yes No

Diagnosis of Hypertension? Yes No

Is your Patient on Dialysis? Yes No

What benefit to risk ratio do you consider acceptable
(number of VTE prevented for 1 major hemorrhage incurred)?
2:1 5:1 10:1