View source for 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

===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: [https://doi.org/10.1378/chest.11-2298 10.1378/chest.11-2298]

[[Category:Perioperative medicine]]
[[Category:Thrombosis]]