Management of VTE related to orthopedic surgery: ICM-VTE Guideline
USA: A recent study in the Journal of Bone and Joint Surgery reports recommendations on the management of venous thromboembolism (VTE) related to orthopedic surgery. The guideline was drafted by International Consensus Meeting on Venous Thromboembolism (ICM-VTE).
The new set of guidelines was issued by a group of 600 international experts that address virtually all aspects of VTE related to orthopedic surgery. The guideline is comprise of a 328-page report, with scores of recommendations, is divided into 10 topics (general, hip/knee, foot/ankle, hand/wrist, shoulder/elbow, spine, oncology, pediatrics, sports, and trauma).
Given below are selected points, drawn from the "general" and "hip/knee" sections, that might be of interest to nonorthopedists who comanage elective surgical patients with orthopedists:
- A history of VTE is a well-known risk factor for postoperative VTE. However, presence of varicose veins and a history of unprovoked superficial venous thrombosis also are risk factors for VTE in lower-limb orthopedic surgery.
- Because scoring systems for VTE risk stratification generally have not been validated in large orthopedic surgery populations, they are not reliable for such patients.
- Although VTE prophylaxis lowers the incidence of postoperative VTE generally, no strong evidence shows that it lowers the incidence of fatal pulmonary embolism.
- The recommended duration of posthospital VTE prophylaxis after hip or knee arthroplasty is 14 to 35 days. Aspirin is the optimal choice, accounting for efficacy, safety, ease of administration, and cost-effectiveness.
- Intermittent compression devices lower the incidence of VTE after hip or knee arthroplasty, but the authors don't specify precisely when such devices should be used in addition to (or as a substitute for) chemoprophylaxis, and they acknowledge that adherence is low after patients leave the hospital.
- For patients with postoperative isolated distal deep venous thrombosis, it is acceptable either to monitor the thrombus (with a follow-up ultrasound in 1 week) or to institute full anticoagulation.
- Taking a nonsteroidal anti-inflammatory drug (NSAID) at the same time as aspirin can negate aspirin's antiplatelet effect. If a patient is receiving postoperative VTE prophylaxis with aspirin plus an NSAID for pain, aspirin should be taken 2 hours before the NSAID (and not with, or immediately after, the NSAID).
Full guideline can be accessed at: https://journals.lww.com/jbjsjournal/toc/2022/03161
