What is the perioperative medication management to prevent deep vein thrombosis (DVT)?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
  • Print
Answer

Answer

Deep vein thrombosis (DVT) is prevalent in major surgery, especially in pelvic and lower limb surgery. Thus, for all major urologic, gynecologic, and rectal operations or surgery for malignancy, preventing this complication is warranted.

Prophylaxis for DVT after hip surgery has developed greatly. Prior to LMWH, an adjusted dose of heparin was administered subcutaneously (5000 U q8h) before surgery and continued until the patient was ambulatory. Maintaining an aPTT outside of the reference range was the goal.

LMWH prevents DVT in patients undergoing abdominal or hip surgery. It has greater efficacy and a lower incidence of bleeding than conventional heparin and produces less inhibition of platelet function.

One of the regimens used in orthopedic surgery is enoxaparin, 30 mg every 12 hours subcutaneously, starting the night before the surgery and postoperatively until the patient is ambulatory.

In cases in which prophylaxis is warranted (eg, abdominal surgery, orthopedic surgery), the following drugs can be used:

  • Enoxaparin (approved in Canada and the United States) is administered at 20 mg subcutaneously 1-2 hours before surgery and once daily postoperatively for moderate-risk patients. A dose of 40 mg with the same schedule is administered to high-risk patients.

  • Dalteparin (approved in Canada and the United States) is administered at 2500 U subcutaneously 1-2 hours before surgery and once daily postoperatively for moderate-risk patients. A dose of 5000 U with the same schedule is administered to high-risk patients.

  • Nadroparin (approved in Canada) is administered at 2850 U subcutaneously 2-4 hours before surgery and once daily postoperatively for moderate-risk patients.

  • Tinzaparin (approved in Canada and the United States) is administered at 3500 U subcutaneously 2 hours before surgery and once daily postoperatively for moderate-risk patients.

  • Fondaparinux sodium (approved in Canada and the United States) is administered at 2.5 mg subcutaneously starting 6 hours postoperatively and once daily thereafter for moderate- and high-risk patients.

Laboratory monitoring of LMWH is only needed in those receiving prolonged treatment or in high-risk patients with a propensity for bleeding or recurrent thrombosis. Its effect can be monitored by heparin assay (antifactor Xa heparin assay, reference range 0.35-0.7 U/mL). Both agents are safe and efficacious in randomized clinical trials, but bleeding still occurs in 3-5% of these patients, especially when heparin is given in concert with nonsteroidal anti-inflammatory drugs (NSAIDs).


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