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Surgical venous thromboembolism prophylaxis: clinical practice update. Hosp Pract (1995) 2020 Dec;48(5):248-257

Date

06/27/2020

Pubmed ID

32589468

DOI

10.1080/21548331.2020.1788893

Scopus ID

2-s2.0-85097968052 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Perioperative medicine continues to evolve as new literature emerges. This article provides an update on prevention of venous thromboembolism (VTE) in surgical patients.

METHODS: We reviewed articles on VTE prevention in surgical patients published in peer-reviewed journals since the publication of 2012 ACCP guidelines on VTE prevention in surgical patients.

RESULTS: Methods of VTE prophylaxis include aggressive ambulation, mechanical prophylaxis, and pharmacological prophylaxis. In non-orthopedic surgery, the overall approach remains assessment of thrombosis risk with the recommendation to use a risk assessment tool such as the modified Caprini score. Low molecular weight heparin (LMWH) appears to be more effective than unfractionated heparin (UFH) for VTE prophylaxis in non-orthopedic surgery. For orthopedic surgery, recent studies now recognize aspirin as an option for VTE prophylaxis after total hip arthroplasty, total knee arthroplasty, and hip fracture surgery. Extended prophylaxis with LMWH reduces the risk of symptomatic VTE in high risk abdominal and pelvic cancer surgery without an appreciable increase in risk of bleeding and decreased symptomatic VTE in major orthopedic surgery but with more minor but not major bleeding. Prophylactic Inferior vena cava (IVC) filter placement or surveillance compression ultrasonography is not recommended in management or detection of VTE in surgical patients.

CONCLUSIONS: This article aims to provide insight into data from last several years which has potential to change clinical practices in perioperative setting.

Author List

Segon YS, Summey RD, Slawski B, Kaatz S

Author

Barbara A. Slawski MD Interim Chief, Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anticoagulants
Female
Heparin, Low-Molecular-Weight
Humans
Male
Middle Aged
Orthopedic Procedures
Perioperative Care
Practice Guidelines as Topic
Risk Factors
United States
Venous Thromboembolism