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General Inpatient Medicine




Infectious Disease








Outpatient & Preventative Medicine


Palliative Care




Pulmonary/Critical Care



Post-op DVT Prophylaxis

Risk for VTE is highest in the first 3 mo after surgery.

Executive summary of ACCP antithrombotic guidelines (8th edition, 2008):



  • i. For hip replacement surgery, recommendations are VTE prophylaxis with LMWH, fondaparinaux or Vit-K antagonist, starting between 12 hrs prior and 24hrs after surgery, at half the usual dose, followed by full dose 24 hrs later.
  • ii. Recommend continuing anticoagulation for at least 10 days and up to 35 days (after total hip or knee replacement or hip fracture surgery), with full dose LMWH, fondaparinaux or VKA
  • iii. Recommend against use of aspirin, low-dose unfractionated heparin or mechanical thromboprophylaxis as the sole method of prophylaxis (unless pt has a very high risk of bleeding)
  • iv. For hip fracture surgery, recommendations are similar to TKA/THA, but do recommend anticoagulation starting at admission (before surgery)
  • v. ACCP guidelines do not recommend routine US screening for DVT before discharge


    ACCP vs. AAOS guidelines: see 2009 Chest article comparing ACCP vs. AAOS guidelines for thromboprophylaxis in knee and hip arthroplasty.



    • i. Guidelines differ in a few key ways, mainly surrounding the issue of DVT as a surrogate marker for PE. 
    • ii. ACCP guidelines interpret a new DVT as a failure of thromboprophylaxis, whereas the AAOS guidelines do not feel that DVT is clearly predictive of PE and therefore should not be considered a failure of thromboprophylaxis

    (Victoria Kelly MD, 9/2/10)