Treatment Major Orthopedic Surgery (THA, TKA, HFS)
ÎFor patients undergoing major orthopedic surgery (THA, TKA, HFS) and receiving LMWH as thromboprophylaxis, the ACCP recommends starting either 12 or more hours preoperatively or postoperatively rather than within 4 hours or less preoperatively or postoperatively (1B).
ÎThe ACCP suggests extending thromboprophylaxis in the outpatient period for up to 35 days from the day of surgery rather than for only 10 to 14 days (2B).
ÎThe ACCP suggests using dual prophylaxis with an antithrombotic agent and an IPCD during the hospital stay (2C).
ÎIf there is an increased risk of bleeding, the ACCP suggests using an IPCD or no prophylaxis rather than pharmacologic treatment (2C).
ÎIf the patient declines or is uncooperative with injections or an IPCD, the ACCP recommends using apixabana or adjusted-dose VKA if apixabana
or dabigatranb and dabigatranb
than alternative forms of prophylaxis (all 1B).
ÎIf the patient has an increased bleeding risk or contraindications to both pharmacologic and mechanical thromboprophylaxis, the ACCP suggests AGAINST using inferior vena cava filter placement for primary prevention over no thromboprophylaxis (2C).
ÎFor asymptomatic patients, the ACCP recommends AGAINST Doppler (or duplex) ultrasound screening before hospital discharge (1B).
Knee Arthroscopy
ÎFor patients without a history of prior VTE, the ACCP suggests NO thromboprophylaxis (2B).
Isolated Lower-Leg Injuries Requiring Leg Immobilization ÎThe ACCP suggests NO prophylaxis (2C).
(alternatively rivaroxaban are unavailable) rather
a
Apixaban was not FDA approved in the United States at the time of the guideline publication. b Not FDA-approved for VTE prevention.
