How is deep venous thrombosis (DVT) risk determined prior to orthopedic surgery?

Updated: Jul 25, 2019
  • Author: David A Forsh, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Answer

A list can be constructed by using the ACCP risk categories. [54]  These figures include a list of the pertinent factors, which are arbitrarily assigned a risk level between 1 and 5. An individual aged 61-75 years is assigned 2 units; a person older than 75 years is assigned a score of 3, as is an individual with a previous history of thrombosis, inherited thrombophilia, antiphospholipid antibodies, or lupusanticoagulant.The total score is then added.

Risk factors are grouped according to severity and are added to produce an overall risk factor score, which corresponds to a low through a very high potential for DVT development.

In risk factor assessment, 1 point is assigned to each of the following:

  • Age 41-60 years
  • Minor surgery
  • History of major surgery within 1 month
  • Pregnancy or postpartum within 1 month
  • Varicose veins
  • Swelling of legs
  • Obesity (body mass index [BMI] >25 kg/m 2)
  • Oral contraceptives, patch, or hormone replacement therapy

Each of the following risk factors is assigned 2 points:

  • Age older than 60 years
  • Malignancy or current chemotherapy or radiation therapy
  • Major surgery (>45 min)
  • Laparoscopic surgery (>45 min)
  • Confined to bed longer than 72 hours
  • Immobilizing cast shorter than 1 month
  • Central venous access for less than 1 month
  • Tourniquet time longer than 45 minutes

The following risk factors are assigned 3 points each:

  • Age older than 75 years
  • History of DVT or PE
  • Family history of thrombosis
  • Factor V Leiden/activated protein C resistance
  • Medical patient with risk factors of myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease
  • Congenital or acquired thrombophilia

Finally, 5 points are assigned to each of the following risk factors:

  • Major, elective lower extremity arthroplasty, TKR, THR
  • Hip, pelvis, or leg fracture within 1 month
  • Stroke within 1 month
  • Multiple trauma within 1 month
  • Acute spinal cord injury with paralysis within 1 month

These factors include those that diminish venous flow or return, increase viscosity, or alter mobility. Age is one of the most easily definable factors. [55] The risk of DVT increases in exponential fashion with increasing age (see the image below).

Time course of deep venous thrombosis risk. Time course of deep venous thrombosis risk.

By using the risk criteria listed above, orthopedic patients can be categorized into four risk groups, ranging from low to very high (see Table 2 below). Appropriate methods of prophylaxis may be applied to each level.

Table 2. Deep Venous Thrombosis Risk Factor Scores (Open Table in a new window)

Risk Factor Score

0-1

2

3-4

5+

DVT Incidence

2%

10-20%

20-40%

40-80%

Risk level

Low

Moderate

High

Very high


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