Prevention Of VTE In Orthopedic Surgery Patients

Publication Date: February 1, 2012

Recommendations

Patients Undergoing Major Orthopedic Surgery: THA, TKA, HFS

In patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), we recommend use of one of the following for a minimum of 10 to 14 days rather than no antithrombotic prophylaxis:
  • LMWH, fondaparinux, apixaban, dabigatran, rivaroxaban, LDUH, adjusted-dose VKA, aspirin,
(1, B)
307795
  • or an intermittent pneumatic compression device (IPCD).
(1, C)
307795
In patients undergoing hip fracture surgery (HFS), we recommend use of one of the following rather than no antithrombotic prophylaxis for a minimum of 10 to 14 days:
  • LMWH, fondaparinux, LDUH, adjusted-dose VKA, aspirin,
(1, B)
307795
  • or an IPCD.
(1, C)
307795
For patients undergoing major orthopedic surgery (THA, TKA, HFS) and receiving LMWH as thromboprophylaxis, we recommend starting either 12 h or more preoperatively or 12 h or more postoperatively rather than within 4 h or less preoperatively or 4 h or less postoperatively. (1, B)
307795
In patients undergoing THA or TKA, irrespective of the concomitant use of an IPCD or length of treatment, we suggest the use of LMWH in preference to the other agents we have recommended as alternatives:
  • fondaparinux, apixaban, dabigatran, rivaroxaban, LDUH,
(2, B)
307795
  • adjusted-dose VKA, or aspirin.
(2, C)
307795
In patients undergoing HFS, irrespective of the concomitant use of an IPCD or length of treatment, we suggest the use of LMWH in preference to the other agents we have recommended as alternatives:
fondaparinux, LDUH, (2, B)
307795
  • adjusted-dose VKA, or aspirin.
(2, C)
307795
In patients undergoing major orthopedic surgery, we suggest using dual prophylaxis with an antithrombotic agent and an IPCD during the hospital stay. (2, C)
307795
In patients undergoing major orthopedic surgery and increased risk of bleeding, we suggest using an IPCD or no prophylaxis rather than pharmacologic treatment. (2, C)
307795
For patients undergoing major orthopedic surgery, we suggest extending thromboprophylaxis in the outpatient period for up to 35 days from the day of surgery rather than for only 10 to 14 days. (2, B)
307795
In patients undergoing major orthopedic surgery and who decline or are uncooperative with injections or an IPCD, we recommend using apixaban or dabigatran (alternatively rivaroxaban or adjusted-dose VKA if apixaban or dabigatran are unavailable) rather than alternative forms of prophylaxis. (1, B)
307795
In patients undergoing major orthopedic surgery, we suggest against using IVC filter placement for primary prevention over no thromboprophylaxis in patients with an increased bleeding risk (Table 4) or contraindications to both pharmacologic and mechanical thromboprophylaxis. (2, C)
307795
For asymptomatic patients following major orthopedic surgery, we recommend against DUS screening before hospital discharge. (1, B)
307795

Isolated Lower-Leg Injuries Distal to the Knee

We suggest no prophylaxis rather than pharmacologic thromboprophylaxis in patients with isolated lower-leg injuries requiring leg immobilization. (2, C)
307795

Knee Arthroscopy

For patients undergoing knee arthroscopy without a history of prior VTE, we suggest no thromboprophylaxis rather than prophylaxis. (2, B)
307795

Recommendation Grading

Disclaimer

Overview

Title

Prevention Of VTE In Orthopedic Surgery Patients

Authoring Organization

Publication Month/Year

February 1, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT.

Target Patient Population

Patients undergo orthopedic surgery

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Long term care, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D054556 - Venous Thromboembolism, D020246 - Venous Thrombosis, D000925 - Anticoagulants, D011315 - Preventive Medicine, D056824 - Upper Extremity Deep Vein Thrombosis, D057909 - Orthognathic Surgery

Keywords

anticoagulation, surgery, antiplatelet agents, Antithrombotic Agents, Venous Thromboembolism, deep vein thrombosis, pulmonary embolism, postoperative care, Anticoagulation

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
135
Literature Search Start Date
January 1, 2008
Literature Search End Date
December 1, 2010