This is the ACCP 8th Edition evidence-based guideline for preventing venous thromboembolism across surgical and medical patient groups. It defines which agents, doses, and durations of prophylaxis are recommended, with each recommendation carrying a formal evidence grade. For orthopedics, it establishes the approved options for hip and knee arthroplasty and hip fracture surgery.
When your patient goes to the OR for a hip or knee replacement, the prophylaxis decision is already made for you by this guideline: LMWH, fondaparinux, or warfarin dosed to INR 2-3, each Grade 1A.
The key orthopedic distinction to memorize is duration. Ten days is the floor for THR, TKR, and HFS. Thirty-five days is the target for hip replacement and hip fracture surgery, because thrombotic events keep occurring after the patient leaves the hospital. Hip fracture surgery is the one setting where fondaparinux stands alone at Grade 1A. Everything else is Grade 1B, a subtle but testable point.
Aspirin alone never qualifies. The 44% versus 28% VTE data against danaparoid is the reason. When bleeding risk is high, switch to mechanical prophylaxis first, then add an anticoagulant once the bleeding risk falls.
This is the ACCP 8th Edition evidence-based guideline for preventing venous thromboembolism across surgical and medical patient groups. It defines which agents, doses, and durations of prophylaxis are recommended, with each recommendation carrying a formal evidence grade. For orthopedics, it establishes the approved options for hip and knee arthroplasty and hip fracture surgery.
When your patient goes to the OR for a hip or knee replacement, the prophylaxis decision is already made for you by this guideline: LMWH, fondaparinux, or warfarin dosed to INR 2-3, each Grade 1A.
The key orthopedic distinction to memorize is duration. Ten days is the floor for THR, TKR, and HFS. Thirty-five days is the target for hip replacement and hip fracture surgery, because thrombotic events keep occurring after the patient leaves the hospital. Hip fracture surgery is the one setting where fondaparinux stands alone at Grade 1A. Everything else is Grade 1B, a subtle but testable point.
Aspirin alone never qualifies. The 44% versus 28% VTE data against danaparoid is the reason. When bleeding risk is high, switch to mechanical prophylaxis first, then add an anticoagulant once the bleeding risk falls.