Guide Appropriate VTE Prophylaxis After Surgery or Hospitalization

When is venous thromboembolism (VTE) prophylaxis needed after hospitalization?

Not very often. Stay alert for appropriate use.

Hip or knee replacement patients. Continue to recommend VTE prophylaxis...usually for 10 to 14 days after knee replacement or 35 days after hip replacement.

Recommend using a direct oral anticoagulant (DOAC), such as Eliquis (apixaban) or Xarelto (rivaroxaban)...or a low-molecular-weight heparin (enoxaparin, etc)...for most patients at higher VTE risk. This includes patients with prior VTE, CV disease, extremely limited mobility, etc.

For lower-VTE-risk patients, consider suggesting a DOAC for 5 days...then switching to aspirin 81 mg/day to finish the course. But explain there's not good evidence for using aspirin alone from the get-go.

Nonsurgical patients. Recent evidence is raising questions about continuing VTE prophylaxis after discharge in high-risk NONsurgical patients...such as an older heart failure patient with reduced mobility.

Explain that using Xarelto for 45 days after discharge in high-risk patients only prevents one symptomatic VTE for every 417 treated...but one in 175 have clinically important bleeding.

The newer DOAC Bevyxxa (betrixaban) has similar results in this situation...and evidence for Eliquis seems even less favorable.

Don't recommend this "extended-duration" VTE prophylaxis.

Also don't routinely recommend VTE prophylaxis for patients with a lower leg injury requiring immobilization, such as a cast...or in patients who are chronically immobilized, such as nursing home residents.

But ensure anticoagulants are continued after discharge for appropriate indications...atrial fib, recent VTE, etc.

Listen to PL Voices for expert advice...and use our chart, Venous Thromboembolism Prophylaxis, for management in cancer, pregnancy, etc.

• PL Voices: Venous Thromboembolism
• Chart: Venous Thromboembolism Prophylaxis