VTE Prophylaxis

#surgery

There are several guidelines for VTE prophylaxis - including from an ANZ working party of the
management and prevention of VTE, and NHMRC clinical practice guidelines.

Risk factors for VTE and haemorrhage

Risk factors for VTE
Patient
Age (incidence rises each decade over 40)
Malignancy
Previous VTE
Obesity
Pregnancy and puerperium
Prolonged immobility - bed rest, plaster, travel
Oestrogen medication
Inherited/acquired thrombophilia
Deficiency - Protein C/S, ATIII deficiency
Presence of - anti-phospholipid antibodies, Factor V Leiden,
hyperhomocysteinaemia, prothrombin gene mutation (20210A)
Acute medical illness - CCF, AMI, CVA, sepsis, chemotherapy
Surgical procedure
Type
Duration of anaesthesia
Duration of post-op immobility
Complications
Risk factors for haemorrhage
Patient related
Ongoing bleeding - recent surgery/trauma, GI ulceration
CNS bleed
Coagulopathy - jaundice/meds
Bleeding disorders
Renal dysfunction
Fall risk
Prophylaxis related
Surgery (dose & timing)
Anaesthesia (epidural)
Methods of VTE prophylaxis
1. Chemical
LDUH, OR
LMWH
Enoxaparin (Clexane)
Dalteparin
Fondaparinux (ortho)
2. Mechanical
Stockings - TEDS or graduated compression stockings providing 16-20mmHg
pressure at the ankle
Contraindicated in PBD
IPC - intermittent pneumatic compression
Intraoperative, high-risk patients post-operatively