The guidelines established by the New York State Workers Compensation Board are designed to assist healthcare professionals in the prevention of Venous Thromboembolic Disease. These directives aim to support physicians and healthcare practitioners in determining appropriate measures for preventing this condition.
Healthcare professionals focusing on the prevention of Venous Thromboembolic Disease can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable preventive strategies for their patients.
It is important to stress that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding prevention should involve collaboration between the patient and their healthcare provider.
Post-operative hip or knee arthroplasty patients face a significant risk of venous thromboembolic disease (VTED), a complication that can lead to both morbidity and mortality.
Medications
Low-Molecular Weight Heparin
Suggested – Consider using low-molecular-weight heparin for preventing venous thromboembolic disease.
Indications: This is particularly relevant for post-operative arthroplasty patients, those with hip fractures, and individuals undergoing major hip surgeries, especially if they experience prolonged inactivity or reduced activity levels.
Patients with prior adverse reactions to LMWH may want to explore alternative treatments initially.
Frequency/Dose/Duration: The ideal duration of treatment lacks consensus, and it’s recommended to tailor it based on individual activity levels. Knowing when to stop – if there’s a major complication, like significant bleeding, or if other adverse effects arise.
Reasoning: In general, major bleeding stands out as the most significant adverse effect associated with most medications used to prevent VTED. Supporting evidence for the use of low-molecular-weight heparin.
Factor Xa Inhibitors
Suggested – Consider using Factor Xa Inhibitors to prevent venous thromboembolic disease.
Indications: This is particularly relevant for post-operative arthroplasty patients, those with hip fractures, or individuals undergoing major hip surgeries, especially if they experience prolonged inactivity or reduced activity levels. Patients with prior adverse reactions may want to explore alternative treatments initially. It’s important to note that individuals with renal failure or insufficiency should generally opt for a different medication due to the renal excretion of this compound. Supporting evidence for the use of Factor Xa Inhibitors.
Warfarin and Heparin
Suggested – Consider Warfarin and Heparin for preventing venous thromboembolic disease, especially for post-operative arthroplasty patients, those with hip fractures, or individuals undergoing major hip surgeries.
Harms: Be aware of an increased risk of bleeding, with a particular concern for intracranial and gastrointestinal bleeds. However, this is somewhat less concerning compared to other options, as the treatment is more readily reversible than low molecular weight heparins or Factor Xa inhibitors.
Frequency/Dose/Duration: Subcutaneous injections of Heparin can be titrated to the activated partial thromboplastin time (aPTT), while Warfarin doses are adjusted to the International Normalized Ratio (INR). Supporting evidence for the use of Warfarin and Heparin.
Aspirin
Suggested – Consider using Aspirin for preventing deep venous thrombosis. Indications: This is particularly relevant for post-operative arthroplasty patients, those with hip fractures, or individuals undergoing major hip surgeries, usually after discontinuing other treatments such as LMWH, heparin, or other anticoagulants.
Treatments
Devices
Compression Stockings
Suggested – Consider the use of compression stockings for preventing Venous Thromboembolic Disease.
Indications: This is especially relevant for all post-operative hip surgery patients, including those with hip fractures, hip arthroplasties, or any others deemed at an increased risk of VTED in the post-operative period. Knowing when to stop: Typically, one month postoperative or upon resumption of all normal activities and activity levels. If normal activities haven’t resumed, use beyond four weeks may be recommended. Evidence supporting the use of compression stockings.
Lower Extremity Pumps
Suggested – Think about lower extremity pumps for preventing venous thromboembolic disease in post-operative major hip surgery patients. Indications: This applies to individuals with hip fractures, hip arthroplasties, or any others believed to be at an increased risk of VTED in the post-operative period.
Frequency/Dose/Duration: Devices can include foot pumps, foot plus calf pumps, entire lower extremity intermittent compression devices, and various other combinations.
Knowing when to stop: Discontinuation is generally advised by 14 days unless ongoing issues, such as delayed rehabilitation and ambulation, indicate an increased risk.
