Venous%20thromboembolism%20-%20prevention Management
Prevention
Specific Group Recommendations for Patients at
Moderate to High Risk for VTE
SPECIFIC GROUP DEPENDING ON RISK FACTOR FOR VTE | RECOMMENDED PREVENTION |
Moderate-risk general surgery |
Any of the following would be appropriate:
|
High-risk general surgery
|
Any of the following would be appropriate:
|
High-risk general surgery patients with multiple risk factors | Any of the following would be appropriate:
Combined with: |
Patients with high risk of bleeding |
|
Major vascular surgery patients with additional thromboembolic risk factors | Any of the following would be appropriate: Mechanical prophylaxis may also be added |
Major gynecologic surgery for benign disease without additional risk factors | Any of the following would be appropriate: |
Extensive gynecologic surgery for malignancy and for patients with additional risk factors | Any of the following would be appropriate: Any of the following alternatives: |
Major trauma with low to moderate risk for bleeding | Any of the following would be appropriate: |
Major open urologic procedures | Any of the following would be appropriate: |
Laparoscopic procedures with additional risk factors | ≥1 of the following would be appropriate: |
Inpatient bariatric surgery | Any of the following would be appropriate: |
Major thoracic surgery | Any of the following would be appropriate: |
Coronary artery bypass surgery (CABG) | Any of the following would be appropriate: |
Elective total hip replacement (THR) | Any of the following would be appropriate: - 4-6 hours post-op at half the usual high-risk dose the following day |
Elective THR with high risk of bleeding |
|
Elective total knee replacement (TKR) | Any of the following would be appropriate: Alternative: |
Hip fracture surgery (HFS) | Any of the following would be appropriate: |
Elective TKR with high risk of bleeding HFS with high risk of bleeding |
|
Arthroscopic knee surgery with additional risk factor or following a complicated procedure |
|
Critical care patients who are at moderate risk or higher risk | Any of the following would be appropriate for moderate risk: For higher risk: |
Anticoagulation contraindicated |
|
Duration of Prophylaxis
Medical Conditions
- The optimal length of thromboprophylaxis in medical patients is yet undetermined
Major General Surgery
- 7-10 days post-surgery or for length of hospitalization
- Appropriate length of prophylaxis should be based on clinical factors (eg mobilization)
- May use an extended antithrombotic prophylaxis (>3 weeks) in patients undergoing major surgery
- For patients who have undergone major cancer surgery or have previous VTE
- Continue LMWH for up to 28 days after discharge
Major Gynecologic Surgery
- Continue prophylaxis until discharge
- For high-risk patients including those who have undergone major cancer surgery or have previous VTE
- Continue LMWH for up to 28 days after discharge
Major Orthopedic Surgery
- At least 10 days post-surgery
- Extended prophylaxis for up to 35 days after THR, TKR and HFS
- Prolonged out-of-hospital prophylaxis should be considered for high-risk patients
- LMWH, Fondaparinux or adjusted-dose Warfarin may be considered for extended out-of-hospital prophylaxis