BARRACK

 

Low or standard risk total knee – ASA 325 mg bid and foot pumps

High risk total knee [previous dvt , obesity] – Coumadin 4 wk target INR 2.0

High risk total knee [previous dvt , obesity] – Coumadin 4 wk target INR 2.0

 

 

AAOS

 

Higher risk of PE

                History of cancer

                History of PE

                Hypercoagulable states [polycythemia]

                Spinal cord injury

                Multi-trauma

 

Higher risk of bleeding

                History of uncontrolled bleeding

                Known coagulation factor deficiency

                Recent history of GI bleed

                Recent hemorrhagic stroke

 

 

 

Standard risk of both PE and major bleeding

                ASA 325 mg bid for 6 weeks [81 mg if GI symptoms]

                LMWH 7-12 days [start 24 hr. post-op]

                Coumadin 2-6 weeks, target INR 2.0 [start the night after surgery]

                Fondaparinux 7-12 days [start 24 hr post-op]

 

Elevated risk of PE – Standard risk of major bleeding

                LMWH 7-12 days [start 24 hr. post-op]

                Coumadin 2-6 weeks, target INR 2.0 [start the night after surgery]

                Fondaparinux 7-12 days [start 24 hr post-op]

 

Standard risk of PE – Elevated risk of major bleeding

ASA 325 mg bid for 6 weeks [81 mg if GI symptoms]

                Coumadin 2-6 weeks, target INR 2.0   [start the night after surgery]

 

Elevated risk of PE  - Elevated risk of major bleeding

ASA 325 mg bid for 6 weeks [81 mg if GI symptoms]

                Coumadin 2-6 weeks, target INR 2.0

 

Foot pumps recommended during hospital stay.  Routine post-op screen for DVT or PE is not.

 

Consider vena cava filter with elevated risk of PE and contraindication to chemoprophylaxis….or if chemoprophylaxis becomes contraindicated in an elevated risk patient during the post-op course.  Consider filter in patients with elevated risk of major bleeding who develop symptomatic post-operative PE.