What are the ACCP guidelines for deep venous thrombosis (DVT) prophylaxis in patients undergoing orthopedic surgery?

Updated: Jan 28, 2021
  • Author: David A Forsh, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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In 2012, the American College of Chest Physicians (ACCP) issued recommendations for VTE prevention in orthopedic surgery patients, based on the ninth edition of its evidence-based clinical practice guidelines for antithrombotic therapy and prevention of thrombosis. [10]

Recommendations for patients undergoing major orthopedic surgery (total hip arthroplasty [THA], total knee arthroplasty [TKA], or hip fracture surgery [HFS]) included the following [10] :

  • In patients underoing TKA or THA, LMWH, fondaparinux, apixaban, dabigatran, rivaroaxaban, LDUH, adjusted-dose vitamin K antagonist (VKA), aspirin, or an IPC device for at least 10-14 days is preferable to no prophylaxis
  • In patients underoing HFS, LMWH, fondaparinux, LDUH, adjusted-dose VKA, aspirin, or an IPC device for at least 10-14 days is preferable to no prophylaxis
  • In patients who receive LMWH, prophylaxis should be started at least 12 hours preoperatively or postoperatively
  • Regardless of concomitant IPC device use or duration of treatment, LMWH is favored over alternative recommended agents
  • Thromboprophylaxis should be extended in the outpatient period for up to 35 days from the day of surgery
  • During the hospital stay, dual prophylaxis with and IPC device and an antithrombotic agent is suggested
  • In patients who are at increased risk for bleeding, an IPC device or no prophylaxis is favored over pharmacologic prophylaxis
  • In patients who refuse or will not cooperate with injections or an IPC device, apixaban or dabigatran (or, if these are unavailable, rivaroxaban or adjusted-dose VKA) is recommended
  • In patients who are at increased risk for bleeding or in whom both mechanical and pharmacologic prophylaxis are contraindicated, placement of an inferior vena cava filter is not recommended
  • In patients who are asymptomatic after surgery, Doppler ultrasound screening before discharge is not recommended

In patients undergoing knee arthroscopy who do not have a prior history of VTE, no thromboprophylaxis was recommended. [10]

The 2016 updates for the 10th edition of the ACCP guidelines did not contain significant changes with regard to VTE prophylaxis (as distinct from treatment) in orthopedic surgery. [11]

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