Perioperative venous thromboembolism prophylaxis

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
  • THA/TKA: LMWH for 14 to 35 days ± IPC
• Start prophylaxis 12 hours post-operatively unless significant bleeding concerns

Medications

• LMWH: enoxaparin 40 mg daily or 30 mg BID, or dalteparin 5000 u daily
• UFH 5000 u BID
• Fondaparinux 2.5 mg daily
• DOACs
  • Dabigatran 220 mg daily
  • Rivaroxaban 10 mg daily
  • Apixaban 2.5 mg BID
• Wardarin

Further Reading

• Chest Guidelines on Antithrombotic Therapy