Guidelines for the prevention of deep vein thrombosis in elective surgery

Incidence of deep vein thrombosis:

There is no definite answer regarding the incidence of deep vein thrombosis in elective surgery. Reasons for this are:

  1. Very few studies published without some form of prophylaxis
  2. Methods of diagnosis vary
  3. Patient populations vary

Recommendations:

Mechanical Prophylaxis:

Compression devices are recommended in elective spinal surgery

Mechanical prophylaxis is reasonable to start just prior or at beginning of surgery and continued until patient is ambulatory

Chemoprophylaxis:

Elective spine surgeries done through a posterior approach only carry a low risk of deep vein thrombosis. Chemoprophylaxis with Low Molecular Weight Heparin or low dose Warfarin carries a high risk of postoperative bleeding and subsequent neurological damage

Anterior-posterior elective surgery has a high risk of deep vein thrombosis as well as patients with malignancy, politrauma or hypercoagulable states

Chemoprophylaxis should be considered on a case-by-case basis to prevent postoperative bleeding

When chemoprophylaxis is used the patient’s neurological status should be monitored

There is no support in the literature to recommend the ideal time to commence with Low Molecular Weight Heparin (LMWH)

LMWH should be used with caution in elective spinal surgery and withheld if there are no other risk factors for thromboembolism

There is no evidence for the ideal duration of chemoprophylaxis. Risk factors such as type of surgery, ambulation and neurological status should be considered

Intravenous heparin should be considered as bridging therapy for patients on anti-coagulation for other conditions i.e. artificial heart valves or coronary stents etc. Heparin is more predictable and controllable than LMAH


(These Guidelines are based on the NASS publication “ Antithrombotic Therapies in Spine surgery”  2009)

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