Prevention Of VTE In Orthopedic Surgery Patients

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

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)
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  • or an intermittent pneumatic compression device (IPCD).
(1, C)
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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)
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  • or an IPCD.
(1, C)
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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)
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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)
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  • adjusted-dose VKA, or aspirin.
(2, C)
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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)
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  • adjusted-dose VKA, or aspirin.
(2, C)
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In patients undergoing major orthopedic surgery, we suggest using dual prophylaxis with an antithrombotic agent and an IPCD during the hospital stay. (2, C)
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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)
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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)
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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)
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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)
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For asymptomatic patients following major orthopedic surgery, we recommend against DUS screening before hospital discharge. (1, B)
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Overview

Title

Prevention Of VTE In Orthopedic Surgery Patients

Authoring Organization

American College of Chest Physicians