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Protocol antithrombotic prophylaxis

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 point2 points3 points4 points
age 41-60 ageage 61-74age ≥ 75cerebral infarction (<1 month)
minor surgeryarthroscopyhistory of VTEelective 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 > 25major open surgery (>45 min)familial occurrence of VTEhip, pelvic or leg fracture
swollen legslaparoscopic surgery (> 45min)Factor V LeidenAcute spinal injury (< 1 month)
varices venesmalignancyProthrombin 20210A
pregnancy or post partumbedridden ≥ 72hLupus anticoagulans
recurrent idiopathic abortionimmobilising plasteranticardiolipin antibodies
oral contraception or hormone replacementcentral venous catheterelevated 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 ScoreRisk stratification of VTEProbability of VTE
0Lowest riskMinimal
1-2Low riskMinimal
3-4Moderate risk0.7%
5-6High risk1.8%
7-8High risk 4.0%
9 or greaterHighest risk10.7%

Prophylactic medication

Low risk

Name medicationMgHow many a dayFor how long
Aspirine (Asaflow)80mg1/d4 weeks

Moderate to high risk

Clexane is also given for 4 weeks.

Name medicationMgHow many a dayFor how long
LMWH (Clexane)40mg1/d4 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.

Updated on June 21, 2021

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