Besides medication after assessing the risks, mobilising is the most important thing.
A good antithrombotic prophylaxis contains the following elements:
- Good patient education (early mobilisation and warning signs of DVT)
- Assessing the risk of the patient and adapt your prophylactic medication accordingly
- Early mobilisation of the patient
Early mobilisation
Exercise 1 of moveUP is standardly activated from day 0 to all patients after knee and hip surgery.
Education of the patient
In the info module “Possible complications after your knee or hip surgery” the patient is educated on the early signs of DVT. The module also stresses the importance of early mobilisation and exercise 1.
Assessing the risk
The risk factors for postoperative thrombosis are cumulative. The individual risk is calculated on the basis of the Modified Caprini Risk Model.
| 1 point | 2 points | 3 points | 4 points |
| age 41-60 age | age 61-74 | age ≥ 75 | cerebral infarction (<1 month) |
| minor surgery | arthroscopy | history of VTE | elective arthroplasty (!this risk factor is not taken into account when estimating the risk of thrombosis in unicondylar and total knee replacement, and hip replacement) |
| BMI > 25 | major open surgery (>45 min) | familial occurrence of VTE | hip, pelvic or leg fracture |
| swollen legs | laparoscopic surgery (> 45min) | Factor V Leiden | Acute spinal injury (< 1 month) |
| varices venes | malignancy | Prothrombin 20210A | |
| pregnancy or post partum | bedridden ≥ 72h | Lupus anticoagulans | |
| recurrent idiopathic abortion | immobilising plaster | anticardiolipin antibodies | |
| oral contraception or hormone replacement | central venous catheter | elevated serum homocysteine | |
| sepsis (<1 month) | heparin-induced thrombocytopenia | ||
| severe pulmonary suffering, including pneumonia (<1 month) | other congenital or acquired thrombophilia | ||
| abnormal lung function | |||
| acute myocardial infarction | |||
| congestive hearth failure | |||
| inflammatory bowel disease | |||
| patient with bed rest |
Risk stratification
| Modified Caprini Score | Risk stratification of VTE | Probability of VTE |
| 0 | Lowest risk | Minimal |
| 1-2 | Low risk | Minimal |
| 3-4 | Moderate risk | 0.7% |
| 5-6 | High risk | 1.8% |
| 7-8 | High risk | 4.0% |
| 9 or greater | Highest risk | 10.7% |
Prophylactic medication
Low risk
| Name medication | Mg | How many a day | For how long |
| Aspirine (Asaflow) | 80mg | 1/d | 4 weeks |
Moderate to high risk
Clexane is also given for 4 weeks.
| Name medication | Mg | How many a day | For how long |
| LMWH (Clexane) | 40mg | 1/d | 4 weeks |
Patients on vit K antagonists (e.g. Marevan) or NOACs: these are stopped preop. LMWH is given 24 hours after the procedure and if the bandage remains dry, we start up the medication again at home, stopping LMWH.