Prevention and management of venous thromboembolism in the surgical patient: options by surgery type and individual patient risk factors

BackgroundCurrent evidence-based guidelines provide recommendations for prophylaxis and treatment of venous thromboembolism (VTE) in a variety of surgical patients.Data sourcesA systematic Ovid Medline search (from 1950 to the present) was conducted for relevant articles using the following search terms: “venous thromboembolism,” “thrombophlebitis,” “thromboembolism,” “pulmonary embolism,” “heparin,” “low-molecular-weight heparin,” “postoperative complications,” and “anticoagulants.”ConclusionsPharmacologic and mechanical approaches are available for VTE prophylaxis, including low-dose unfractionated heparin, low-molecular-weight heparin, vitamin K antagonists, fondaparinux, intermittent pneumatic compression devices, and graduated compression stockings. Permanent inferior vena cava filters are not recommended for primary VTE prophylaxis, although they do have a role in the prevention of pulmonary embolism in patients with recent VTE who cannot have surgery delayed. Retrievable inferior vena cava filters are under investigation for primary VTE prophylaxis in trauma patients. New anticoagulants that inhibit factor Xa and thrombin will soon be available for the prevention and treatment of VTE in surgical patients.