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):

 

(http://chestjournal.chestpubs.org.laneproxy.stanford.edu/content/133/6_suppl/71S.full)

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.

 

(http://sfx.stanford.edu.laneproxy.stanford.edu/local?sid=Entrez:PubMed&id=pmid:19201714)

• 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)