Perioperative venous thromboembolism prophylaxis: Difference between revisions
From IDWiki
(Imported from text file) |
No edit summary |
||
| Line 1: | Line 1: | ||
| − | == |
+ | ==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=== |
| − | * 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 |
| − | * DOACs |
||
| + | **Direct oral anticoagulants |
||
| − | ** Dabigatran 220 mg daily |
||
| − | ** |
+ | ***[[Dabigatran]] 220 mg daily |
| + | ***[[Rivaroxaban]] 10 mg daily |
||
| − | ** |
+ | ***[[Apixaban]] 2.5 mg BID |
| − | * Wardarin |
||
| + | **[[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] |
||
| − | * Chest Guidelines on Antithrombotic Therapy |
||
[[Category:Perioperative medicine]] |
[[Category:Perioperative medicine]] |
||
Revision as of 11:00, 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
Further Reading
- Perioperative Management of Antithrombotic Therapy. CHEST. 2012(141)2:e326S-e350S. doi: 10.1378/chest.11-2298
