VTE in Surgical Patients

This section covers the treatment of VTE in orthopaedic and other surgical patients

Major orthopaedic surgery

  • Major orthopaedic surgery, such as elective hip or knee replacement surgery and hip fracture surgery, is associated with a high risk of VTE as a result of hypercoagulability caused by trauma and/or surgery
  • Without thromboprophylaxis, the incidence of DVT (as assessed by venography) is 40–60% after elective hip or knee replacement surgery and is as high as 60% after hip fracture surgery
  • The risk of VTE after major orthopaedic surgery persists after hospital discharge; total hip replacement, in particular, places patients at continued risk of late-onset VTE at least up to
    35 days after surgery, for which extended duration thromboprophylaxis is recommended

Other surgical patients

General and emergency surgery:

  • Without thromboprophylaxis, the incidence of DVT after general surgery is 15–30%; PE risk is approximately 0.08%
  • Duration of hospitalization and type of surgery affect thrombosis risk, as do factors including increasing age, cancer, prior VTE and obesity

Major gynaecological, major open urological and neurological surgery:

  • Major gynaecological surgery poses a VTE risk similar to that of general abdominal surgery
    (15–40% without preventive therapy)
  • Major open urological or gynaecological procedures confer significant risk, but transurethral procedures do not
  • Venographic studies in patients undergoing neurosurgery show a DVT rate of ~30%; the risk is increased:
    • After cranial surgery compared with spinal surgery
    • In association with malignant tumours compared with benign tumours
    • In patients with leg weakness

Next section: VTE in Immobilized Patients

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