Prevention of venous thromboembolism in surgical patients: why and how?

Venous thromboembolism (VTE) is one of the most common and easily preventable complications following surgical procedures. Anticoagulant prophylaxis has been shown to be highly effective, safe and cost-effective in the prevention of VTE in a large number of surgical groups and should be routinely utilized in these patients. Mechanical prophylaxis should be reserved primarily for the small proportion of patients with a very high bleeding risk. In general surgery, and major gynecologic or urologic surgery, low dose heparin or low molecular weight heparin are recommended options. For hip and knee arthroplasty and hip fracture surgery, the recommended options are low molecular weight heparin, fondaparinux, and dose-adjusted warfarin. Almost all trauma and critical care patients should receive thromboprophylaxis, although individual prophylaxis decisions should be based on the thrombosis and bleeding risks, both of which may change over time. Anticoagulant thromboprophylaxis can be implemented concomitantly with regional anesthesia and continuous epidural analgesia as long as a few basic principles are followed and caution is used.