What are the ESA guidelines for prophylaxis for venous thromboembolism (VTE) in elderly persons undergoing surgery?

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

Answer

In September 2017, the European Society of Anesthesiology issued the following guidelines regarding prophylaxis for VTE in elderly patients undergoing surgery [56] :

  • 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 UFH may be used or weight-adjusted dosing of 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

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!