Prevention Of VTE In Nonorthopedic Surgical Patients

Publication Date: February 1, 2012
Last Updated: March 14, 2022

Recommendations

Risk Stratification, Rationale for Prophylaxis, and Recommendations in General, Abdominal-Pelvic, Bariatric, Vascular, and Plastic and Reconstructive Surgery

For general and abdominal-pelvic surgery patients at very low risk for VTE ( <0.5%; Rogers score, <7; Caprini score, 0), we recommend that
  • no specific pharmacologic
(1, B)
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  • or mechanical
(2, C)
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prophylaxis be used other than early ambulation.
For general and abdominal-pelvic surgery patients at low risk for VTE (~1.5%; Rogers score, 7-10; Caprini score, 1-2), we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis. (2, C)
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For general and abdominal-pelvic surgery patients at moderate risk for VTE (~3.0%; Rogers score, >10; Caprini score, 3-4) who are not at high risk for major bleeding complications, we suggest
  • LMWH,
(2, B)
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  • LDUH,
(2, B)
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  • or mechanical prophylaxis, preferably with IPC,
(2, C)
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over no prophylaxis.
For general and abdominal-pelvic surgery patients at moderate risk for VTE ( ~3.0%; Rogers score, >10; Caprini score, 3-4) who are at high risk for major bleeding complications or those in whom the consequences of bleeding are thought to be particularly severe, we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis. (2, C)
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For general and abdominal-pelvic surgery patients at high risk for VTE ( ~6.0%; Caprini score, ≥5) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with
  • LMWH
(1, B)
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  • or LDUH
(1, B)
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over no prophylaxis.
We suggest that mechanical prophylaxis with ES or IPC should be added to pharmacologic prophylaxis. (2, C)
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For high-VTE-risk patients undergoing abdominal or pelvic surgery for cancer who are not otherwise at high risk for major bleeding complications, we recommend extended-duration pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis. (1, B)
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For high-VTE-risk general and abdominal-pelvic surgery patients who are at high risk for major bleeding complications or those in whom the consequences of bleeding are thought to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated. (2, C)
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For general and abdominal-pelvic surgery patients at high risk for VTE ( ~6%; Caprini score, ≥5) in whom both LMWH and unfractionated heparin are contraindicated or unavailable and who are not at high risk for major bleeding complications, we suggest
  • low-dose aspirin,
(2, C)
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  • fondaparinux
(2, C)
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  • or mechanical prophylaxis, preferably with IPC,
(2, C)
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over no prophylaxis.
For general and abdominal-pelvic surgery patients, we suggest that an IVC filter should not be used for primary VTE prevention. (2, C)
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For general and abdominal-pelvic surgery patients, we suggest that periodic surveillance with venous compression ultrasonography (VCU) should not be performed. (2, C)
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Overview

Title

Prevention Of VTE In Nonorthopedic Surgical Patients

Authoring Organization

American College of Chest Physicians