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VENOUS THROMBOEMBOLISM - PREVENTION
Venous thromboembolism is comprised of pulmonary embolism and deep venous thrombosis and is associated with significant morbidity and mortality.
Decision on which type of prophylaxis to be given must be individualized for each patient.
All patients admitted for major trauma, surgery or acute medical illness should be assessed for risk of venous thromboembolism and bleeding before starting prophylaxis for venous thromboembolism.
Early mobilization and leg exercises for any patient recently immobilized are recommended. Immobilized patients should also be adequately hydrated.
Intermittent pneumatic compression devices periodically compress calf and/or thighs and stimulate fibrinolysis. It has been shown to be effective in prophylaxis of asymptomatic deep venous thrombosis in surgical patients.
Graduated compression stockings may be used for deep venous thrombosis prophylaxis in surgical patients with no contraindication for use.

Duration of Prophylaxis

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)
  • For patients who have undergone major cancer surgery or have previous VTE 
    • Continue LMWH for up to 28 days after discharge

Medical Conditions

  • The optimal length of thromboprophylaxis in medical patients is yet undetermined

Major Orthopedic Surgery

  • At least 10 days post-surgery
  • Extended prophylaxis for up to 35 days after total hip replacement (THR), total knee replacement (TKR) and hip fracture surgery (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

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
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