Perioperative Thromboprophylaxis Guidelines

Patient Risk Factors

The American College of Chest Physicians recommends that patient risk factors such as age over 60 years, history of venous thromboembolism (VTE), active cancer, obesity, and prolonged immobilization should be documented and considered when assessing the risk of thrombosis 1, 2, 3
The presence of thrombophilias is also a significant risk factor for VTE 4

The American Society of Clinical Oncology recommends that patients with cancer undergoing major surgery should receive pharmacological prophylaxis, as they have a higher risk of postoperative VTE and fatal pulmonary embolism 1, 2, 3
Low molecular weight heparin (LMWH) is the preferred agent for pharmacological prophylaxis, with a recommended dose of 40 mg subcutaneously once daily 1, 2
The duration of prophylaxis should be at least 7-10 days postoperatively, and extended prophylaxis (up to 4 weeks) is recommended for patients with high-risk features, such as cancer, residual disease, obesity, or history of VTE 1, 2, 3

The American College of Chest Physicians recommends that mechanical prophylaxis, such as intermittent pneumatic compression devices (IPCDs), should be used in addition to pharmacological prophylaxis for patients at high risk of VTE 5, 6, 7, 8
IPCDs should be used for at least 18 hours per day, and the goal is to achieve 18 hours of compliance per day 5, 6, 7, 8

Patients with myeloproliferative neoplasms, such as polycythemia vera and essential thrombocythemia, have an increased risk of both thrombosis and bleeding, and require multidisciplinary management perioperatively 10
The National Comprehensive Cancer Network recommends that patients with these conditions should have optimal control of thrombotic and hemorrhagic risk before elective surgery, and consider extended prophylaxis with LMWH for high-risk surgeries 10

The American College of Chest Physicians recommends that patients undergoing major orthopedic surgery, such as hip or knee arthroplasty, should receive pharmacological prophylaxis with LMWH or other anticoagulants, and mechanical prophylaxis with IPCDs 5, 6, 7, 8
The duration of prophylaxis should be extended to up to 35 days postoperatively for these patients 5, 6, 7, 8

Subprescription of prophylaxis, inadequate duration of prophylaxis, and failure to extend prophylaxis in high-risk patients are common errors that can compromise patient safety 3, 9
The use of mechanical methods as monotherapy, except when pharmacological prophylaxis is contraindicated, is also inadequate 1, 2, 3