Journal Article

Perioperative Venous Thromboembolism Prophylaxis

Mauck, Karen F., Bartlett, Matthew A., Stephenson, Christopher R., Daniels, Paul R., Ganesh, Ravindra

2020

Overview

Venous thromboembolism (VTE) is a preventable cause of postoperative morbidity and mortality; however, audits suggest that the use of thromboprophylaxis is underused. In this review, we describe our approach to prevention of postoperative VTE and provide guidance on how to formulate an optimal VTE prophylaxis plan. We recommend that all patients undergo thrombosis- and bleeding-risk assessment as part of their preoperative evaluation. The risk of thrombosis can be estimated based on patient- and procedure-specific factors, using validated risk-assessment models such as the Caprini score. There are no validated models to predict perioperative bleeding; however, several risk factors have been proposed. Patients should ambulate early and frequently after surgery. We recommend no additional prophylaxis in patients at very low risk of VTE (Caprini score 0). Patients at low risk of VTE (Caprini 1 to 2) are recommended to receive either mechanical or pharmacological prophylaxis. Patients at moderate (Caprini 3 to 4) to high risk of VTE (Caprini ≥5) are recommended pharmacological prophylaxis either alone or combined with mechanical prophylaxis. Patients at high risk of bleeding should receive mechanical prophylaxis until their risk of bleeding is reduced and pharmacological prophylaxis can be reconsidered. Populations for which the Caprini score has not been validated (such as orthopedic surgery) are recommended prophylaxis based on individual and procedure-specific risk factors. Prophylaxis is typically continued until the patient is ambulatory or until hospital dismissal; however, longer durations can be considered in certain circumstances (high-risk patients undergoing malignant abdominopelvic operations, bariatric operations, and certain orthopedic operations).

• Publisher: Elsevier Inc,Elsevier, Inc,Frontline Medical Communications Inc,Elsevier Limited
• Subject: Bleeding / Bone surgery / Chemoprevention - methods / Clinical medicine / Humans / Medical research / Medicine, Experimental / Methods / Morbidity / Orthopedics / Patients / Perioperative care / Postoperative Complications - prevention & control / Preoperative Care - methods / Prevention / Prophylaxis / Risk Adjustment - methods / Risk assessment / Risk Assessment - methods / Risk factors / Risk groups / Surgery / Surgical Procedures, Operative - adverse effects / Surgical Procedures, Operative - methods / Thoracic surgery / Thromboembolism / Thrombosis / Venous Thromboembolism - etiology / Venous Thromboembolism - prevention & control