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
- Total hip or knee arthroplasty: LMWH for 14 to 35 days ± IPC
Start prophylaxis 12 hours post-operatively unless significant bleeding concerns

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