What are the EAS guidelines for venous thromboembolism (VTE) prophylaxis in elderly surgical patients?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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In September 2017, the European Society of Anesthesiology (ESA) issued the following guidelines regarding prophylaxis for venous thromboembolism (VTE) in elderly patients undergoing surgery [84] :

  • The risk for postoperative VTE is increased in patients older than 70 years and in elderly patients presenting with comorbidities, such as cardiovascular disorders, malignancy, or renal insufficiency; therefore, risk stratification, correction of modifiable risks, and sustained perioperative thromboprophylaxis are essential in this patient population
  • Timing and dosing of pharmacoprophylaxis may be adopted from the younger population
  • Direct oral anticoagulants are effective and well tolerated in the elderly; statins may not replace pharmacologic thromboprophylaxis
  • Early mobilization and use of nonpharmacologic means of thromboprophylaxis should be exploited
  • In elderly patients, suggest identification of comorbidities increasing the risk for VTE (eg, congestive heart failure, pulmonary circulation disorder, renal failure, lymphoma, metastatic cancer, obesity, arthritis, post-menopausal estrogen therapy) and correction if present (eg, anemia, coagulopathy)
  • Suggest against bilateral knee replacement in elderly and frail patients
  • Suggest timing and dosing of pharmacologic VTE prophylaxis as in the younger population
  • In elderly patients with renal failure, low-dose unfractionated heparin (UFH) may be used or weight-adjusted dosing of low-molecular-weight heparin (LMWH)
  • In the elderly, recommend careful prescription of postoperative VTE prophylaxis and early postoperative mobilization
  • Recommend multifaceted interventions for VTE prophylaxis in elderly and frail patients, including pneumatic compression devices, LMWH, and/or direct oral anticoagulants after knee or hip replacement

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