Perioperative venous thromboembolism prophylaxis: Difference between revisions

Revision as of 15:00, 29 July 2020

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

@@ Line 1: / Line 1: @@
-== Management ==
+==Management==
-* Non-orthopedic surgery
+*Non-orthopedic surgery
-** Can estimate risk using Caprini and Rogers scores
+**Can estimate risk using Caprini and Rogers scores
-** If very low risk, no prophylaxis
+**If very low risk, no prophylaxis
-** If low risk, intermittent pneumatic compression (IPC)
+**If low risk, intermittent pneumatic compression (IPC)
-** If moderate risk, IPC or UFH/LMWH
+**If moderate risk, IPC or UFH/LMWH
-** If high risk, UFH/LMWH
+**If high risk, UFH/LMWH
-** If cancer, continue prophylaxis for 4 weeks
+**If cancer, continue prophylaxis for 4 weeks
-** If significant bleeding risk, consider fondaparinux or aspirin
+**If significant bleeding risk, consider fondaparinux or aspirin
-* Orthopedic surgery
+*Orthopedic surgery
-** THA/TKA: LMWH for 14 to 35 days ± IPC
+**Total hip or knee arthroplasty: LMWH for 14 to 35 days ± IPC
-* Start prophylaxis 12 hours post-operatively unless significant bleeding concerns
+*Start prophylaxis 12 hours post-operatively unless significant bleeding concerns
-=== Medications ===
+===Medications===
-* LMWH: enoxaparin 40 mg daily or 30 mg BID, or dalteparin 5000 u daily
+*In general, prefer [[low molecular weight heparin]] (LMWH): [[enoxaparin]] 40 mg daily or 30 mg BID, or [[dalteparin]] 5000 u daily
-* UFH 5000 u BID
+*If renal failure, can use [[unfractionated heparin]] (UFH) 5000 u BID
+*Alternatives include:
-* Fondaparinux 2.5 mg daily
+**[[Fondaparinux]] 2.5 mg daily
-* DOACs
+**Direct oral anticoagulants
-** Dabigatran 220 mg daily
-** Rivaroxaban 10 mg daily
+***[[Dabigatran]] 220 mg daily
+***[[Rivaroxaban]] 10 mg daily
-** Apixaban 2.5 mg BID
+***[[Apixaban]] 2.5 mg BID
-* Wardarin
+**[[Warfarin]]
-== Further Reading ==
+==Further Reading==
+*Perioperative Management of Antithrombotic Therapy. ''CHEST''. 2012(141)2:e326S-e350S. doi: [https://doi.org/10.1378/chest.11-2298 10.1378/chest.11-2298]
-* Chest Guidelines on Antithrombotic Therapy
 [[Category:Perioperative medicine]]