Perioperative venous thromboembolism prophylaxis
From IDWiki
Management
- Non-orthopedic surgery
- Can estimate risk using Caprini and Rogers scores
- If very low risk, no prophylaxis
- If low risk, intermittent pneumatic compression (IPC)
- If moderate risk, IPC or UFH/LMWH
- If high risk, UFH/LMWH
- If cancer, continue prophylaxis for 4 weeks
- If significant bleeding risk, consider fondaparinux or aspirin
- Orthopedic surgery
- Total hip or knee arthroplasty: LMWH for 14 to 35 days ± IPC
- Start prophylaxis 12 hours post-operatively unless significant bleeding concerns
Medications
- In general, prefer low molecular weight heparin (LMWH): enoxaparin 40 mg daily or 30 mg BID, or dalteparin 5000 u daily
- If renal failure, can use unfractionated heparin (UFH) 5000 u BID
- Alternatives include:
- Fondaparinux 2.5 mg daily
- Direct oral anticoagulants
- Dabigatran 220 mg daily
- Rivaroxaban 10 mg daily
- Apixaban 2.5 mg BID
- Warfarin
Further Reading
- Perioperative Management of Antithrombotic Therapy. CHEST. 2012;141(2):e326S-e350S. doi: 10.1378/chest.11-2298