Prevention of VTE in orthopedic surgery patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines

  • Falck-Ytter Y
  • Francis C
  • Johanson N
 et al. 
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Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives(Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay(Grade 2C). We suggest extending thromboprophylaxis for up to 35 days(Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis(Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran(all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis(Grade 2C). We recommend against Doppler(or duplex) ultrasonography screening before hospital discharge(Grade 1B). For patients with isolated low-erextremity injuries requiring leg immobilization, we suggest no thromboprophylaxis(Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Conclusions: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches. 2012 American College of Chest Physicians.

Author-supplied keywords

  • *anticoagulant agent/ct [Clinical Trial]
  • *anticoagulant agent/dt [Drug Therapy]
  • *anticoagulant therapy
  • *evidence based medicine
  • *orthopedic surgery
  • *practice guideline
  • *surgical patient
  • *venous thromboembolism/co [Complication]
  • *venous thromboembolism/di [Diagnosis]
  • *venous thromboembolism/dt [Drug Therapy]
  • *venous thromboembolism/pc [Prevention]
  • *venous thromboembolism/th [Therapy]
  • Doppler echography
  • acetylsalicylic acid/ae [Adverse Drug Reaction]
  • acetylsalicylic acid/cm [Drug Comparison]
  • acetylsalicylic acid/ct [Clinical Trial]
  • acetylsalicylic acid/do [Drug Dose]
  • acetylsalicylic acid/dt [Drug Therapy]
  • acetylsalicylic acid/po [Oral Drug Administration]
  • antivitamin K/ae [Adverse Drug Reaction]
  • antivitamin K/cm [Drug Comparison]
  • antivitamin K/ct [Clinical Trial]
  • antivitamin K/do [Drug Dose]
  • antivitamin K/dt [Drug Therapy]
  • apixaban/ae [Adverse Drug Reaction]
  • apixaban/cm [Drug Comparison]
  • apixaban/ct [Clinical Trial]
  • apixaban/dt [Drug Therapy]
  • apixaban/po [Oral Drug Administration]
  • bleeding/si [Side Effect]
  • blood transfusion
  • brain hemorrhage/si [Side Effect]
  • brain hemorrhage/th [Therapy]
  • compression garment
  • dabigatran/ae [Adverse Drug Reaction]
  • dabigatran/cm [Drug Comparison]
  • dabigatran/ct [Clinical Trial]
  • dabigatran/do [Drug Dose]
  • dabigatran/dt [Drug Therapy]
  • dabigatran/po [Oral Drug Administration]
  • deep vein thrombosis/co [Complication]
  • deep vein thrombosis/dt [Drug Therapy]
  • deep vein thrombosis/pc [Prevention]
  • device therapy
  • dosage schedule comparison
  • dose calculation
  • drug choice
  • drug dose comparison
  • drug efficacy
  • drug fatality/si [Side Effect]
  • drug megadose
  • drug preference
  • drug safety
  • enoxaparin/ae [Adverse Drug Reaction]
  • enoxaparin/cm [Drug Comparison]
  • enoxaparin/ct [Clinical Trial]
  • enoxaparin/do [Drug Dose]
  • enoxaparin/dt [Drug Therapy]
  • evening dosage
  • fondaparinux/ae [Adverse Drug Reaction]
  • fondaparinux/cm [Drug Comparison]
  • fondaparinux/ct [Clinical Trial]
  • fondaparinux/dt [Drug Therapy]
  • hematemesis/si [Side Effect]
  • hematoma/si [Side Effect]
  • hematuria/si [Side Effect]
  • heparin/cm [Drug Comparison]
  • heparin/ct [Clinical Trial]
  • heparin/do [Drug Dose]
  • heparin/dt [Drug Therapy]
  • high risk patient
  • hip fracture/su [Surgery]
  • hip surgery
  • hospital discharge
  • human
  • immobilization
  • inferior cava vein
  • intermittent pneumatic compression device
  • knee arthroscopy
  • leg injury/th [Therapy]
  • length of stay
  • low drug dose
  • low molecular weight heparin/ae [Adverse Drug Reac
  • low molecular weight heparin/cm [Drug Comparison]
  • low molecular weight heparin/ct [Clinical Trial]
  • low molecular weight heparin/dt [Drug Therapy]
  • lung embolism/co [Complication]
  • lung embolism/dt [Drug Therapy]
  • lung embolism/pc [Prevention]
  • medical society
  • nadroparin/ct [Clinical Trial]
  • nadroparin/dt [Drug Therapy]
  • outcome assessment
  • patient compliance
  • placebo
  • priority journal
  • randomized controlled trial (topic)
  • review
  • risk assessment
  • risk benefit analysis
  • risk reduction
  • rivaroxaban/ae [Adverse Drug Reaction]
  • rivaroxaban/cm [Drug Comparison]
  • rivaroxaban/ct [Clinical Trial]
  • rivaroxaban/dt [Drug Therapy]
  • rivaroxaban/po [Oral Drug Administration]
  • stroke/dt [Drug Therapy]
  • systematic review
  • thrombosis prevention
  • total hip prosthesis
  • total knee replacement
  • treatment contraindication
  • treatment duration
  • vena cava filter
  • wound complication/si [Side Effect]
  • wound hematoma/si [Side Effect]
  • wound leakage/si [Side Effect]

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  • Y Falck-Ytter

  • Charles W Francis

  • Norman A Johanson

  • Catherine Curley

  • Ola E Dahl

  • Sam Schulman

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