Venous thromboembolism prophylaxis in high-risk orthopedic and cancer surgery

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ABSTRACT

Orthopedic surgery and surgery for cancer are major risk factors for venous thromboembolism (VTE). Deep vein thrombosis (DVT) can occur in up to 50% of patients after major orthopedic surgery. The rate of VTE after cancer surgery varies according to the type of surgery, with rates as high as those after orthopedic surgery in certain settings. Use of thromboprophylaxis in these high-risk settings is well established and recent studies inform the type and duration of thromboprophylaxis. With major orthopedic surgery, there has been a shift from use of low molecular weight heparins (LMWHs) to direct oral anticoagulants (DOACs) along with renewed interest in aspirin as a thromboprophylaxis agent. Recent studies have also informed optimal thromboprophylaxis strategies after nonmajor orthopedic surgery. Use of thromboprophylaxis after major cancer surgery for cancer is established and recent evidence has focused on the potential benefits of extended-duration thromboprophylaxis. This review will summarize emerging evidence for thromboprophylaxis after orthopedic and cancer surgery with a view to providing clinicians with concise and actionable guidance for best practice.

KEYWORDS:

• Thrombosis
• prophylaxis
• post-operative
• cancer
• orthopedic
• surgery
• anticoagulant

Transparency

Declaration of funding

No funding was received to produce this article

Declaration of financial/other relationships

JD has received funds for consulting/lectures from relevant companies: Pfizer, Leo Pharma, Sanofi, BMS-Pfizer, Janssen, Servier in the last 3 years .

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

No potential conflict of interest was reported by the authors.