CHEST Guidelines-Prevention-of-VTE-in-Orthopedic-Surgery-Patients

Prevention-of-VTE-in-Orthopedic-Surgery-Patients_c

Pdf Summary

The 9th Edition of the American College of Chest Physicians (ACCP) Guidelines addresses the prevention of venous thromboembolism (VTE) in orthopedic surgery patients. VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant complication after major orthopedic surgeries, such as total hip arthroplasty (THA), total knee arthroplasty (TKA), and hip fracture surgeries (HFS).

<strong>Key Recommendations:</strong>
1. <strong>Prophylaxis Duration</strong>: Antithrombotic prophylaxis should be administered for at least 10 to 14 days, and extended for up to 35 days post-surgery where appropriate.
  
2. <strong>Preferred Prophylaxis Agents</strong>: Low-molecular-weight heparin (LMWH) is recommended over other agents like fondaparinux, aspirin, apixaban, dabigatran, rivaroxaban, LDUH, and vitamin K antagonists due to its effectiveness and safety profile.

3. <strong>Timing of Administration</strong>: LMWH should be started either 12 hours or more preoperatively or postoperatively, instead of close to the time of surgery, to minimize bleeding risk.

4. <strong>Dual Prophylaxis</strong>: The addition of an intermittent pneumatic compression device (IPCD) to pharmacologic prophylaxis during the hospital stay is suggested to enhance prevention, especially in patients with increased bleeding risk, where mechanical devices can be used alone.

5. <strong>Contraindicated Prophylaxis</strong>: The guidelines advise against using inferior vena cava (IVC) filters for primary prevention in high bleeding risk patients without mechanical or pharmacological thromboprophylaxis due to a lack of clear benefits and potential harms.

6. <strong>Special Considerations</strong>: Routine Doppler ultrasonography screening for asymptomatic DVT in post-operative patients is not recommended. For isolated lower-leg injuries with immobilization and knee arthroscopy patients without prior VTE history, prophylaxis is not recommended.

Overall, these guidelines advocate a balanced approach to VTE prevention, emphasizing the efficacy of thromboprophylaxis in reducing symptomatic events while considering patient-specific risk factors, convenience, and bleeding risks. Adherence to these guidelines can help reduce VTE incidences post-orthopedic surgery and improve patient outcomes. The guidelines are bolstered by evidence from randomized trials and other studies, focusing on both the effectiveness of various thromboprophylactic measures and their potential risks, including bleeding complications.

Keywords

ACCP Guidelines

venous thromboembolism

orthopedic surgery

deep vein thrombosis

pulmonary embolism

prophylaxis duration

low-molecular-weight heparin

intermittent pneumatic compression

inferior vena cava filters

thromboprophylaxis