ANZ Working Party on the Management and Prevention of Venous Thromboembolism 2007
Note
Top 6 conditions associated with DVT
- stroke
- THR
- multi trauma
- TKR
- hip fracture
- spinal cord injury
Not one of the 12 doctors was an orthopaedic surgeon
Agents
Heparin / LMWH / fondaparinux
- confirmed effectiveness
Aspirin
- not recommended
- at best weak effect in some people
Warfarin
- a role in some high risk surgical patient
- requires monitoring
Timing
Inconclusive in many areas
Recommend 28 - 35 days in
- hip fracture
- THR
Epidural Catheter
No anticoagulant within 12 hours of inserting / 6 hours of withdrawing epidural catheter
Mechanical compression
Graduated compression / intermittent pneumatic compression / foot pumps have all been shown to work
Recommended to combine with chemoprophylaxis
Use unless contra-indicated
- severe peripheral arterial disease or neuropathy
Specific Recommendations
THR / Hip Fracture
Enoxaparin 40 mg / day commencing 6 - 8 hours post op for 28 - 35 days
TKR / Multi-trauma / Prior VTE / Cancer
Enoxaparin 40 mg / day commencing 6 - 8 hours post op
Post op for 5 - 10 days
Major Surgery (any surgery > 45 minutes)
Enoxaparin 20 mg / day commencing 6 - 8 hours post op for 5 - 10 days
High risk patients
Oestrogen therapy
Pregnancy
Obesity
Strong FHx VTE
Contraindications to chemoprophylaxis
Active bleeding
High risk bleeding
- hemophilia
- platelets < 50
- history GI bleeding
Severe hepatic disease (INR < 1.3)
Allergic to heparin
High risk of falls
Palliative Management
Results
CRISTAL study group JAMA 2022
- RCT 100mg aspirin v 40 mg enoxeparin in 9711 THA and TKA patients
- symptomatic VTE in aspirin group was 3.5%
- symptomatic VTE in enoxeparin group was 1.8%
https://pubmed.ncbi.nlm.nih.gov/35997730/