• Many efforts have been made to reduce VTE events, some of which have been associated with hospital and physicians well as reimbursement.
• Deep Vein Thromboses (DVT) usually develop in the legs after surgery due to patients not being as mobile and sometimes having weight bearing restrictions on affected extremity.
• A small percentage of patients may develop a pulmonary embolism (PE) from the blood clot traveling to the lungs. Certain patients are at greater risk for developing a VTE than others based on their comorbidities as well as the type of surgery being performed.

Risks:

• The risk of VTE and prophylaxis are different in orthopaedic versus abdominal or heart surgery largely due to restricted weight bearing status and location of orthopaedic operations. It is important to recognize the factors prior to orthopaedic surgery, and plan accordingly for proper VTE prophylaxis.
• Caution should be taken for those patients with clotting disorders – both increased and decreased clotting ability.
• Some of the more potent anticoagulants have a higher association with blood forming in the joint or in the surrounding tissues and causing wound complications.

A patient could have history of hypercoagulable state if they have hereditary clotting disorders such as the following:

• Antithrombin Deficiency
• Factor V Leiden
• Protein C and Protien S Defficiencies
• Prothrombin Mutation (Factor II)

Surgeon Tools/Recommendations:

Recognize risk factors prior to orthopaedic surgery and plan accordingly for proper VTE prophylaxis. Ask patients about any history in themselves or family of blood clotting disorder.

Patients may also have an increased risk of bleeding (hypercoagulable state) if they have one or many blood disorders.

Risk Stratification remains controversial within orthopaedics especially with the various types of procedures performed.

• The VTEstimator is a simple resource and app developed by Orthopaedic surgeons that allows you to input patient’s risk factors and medical history then provides a risk category (i.e. risk stratification) and subsequent recommendations for anticoagulant choice.
• Recognize risk factors prior to orthopaedic surgery and plan accordingly for proper VTE prophylaxis.
• Patients may also have an increased risk of bleeding if they have an underlying blood clotting disorder. Ask your patients about any history in themselves or family of blood clotting or bleeding disorders.

Anticoagulation

• When deciding on whether to administer anticoagulation, the timing and which anticoagulant to give, it is important to remember that there are some conditions in which patients cannot receive a specific anticoagulant or antiplatelet agent:
  • Low platelet count ( <90,000)
  • History of gastrointestinal bleeding - Caution with Aspirin, consult PCP
  • Active peptic ulcer disease – Should NOT receive Aspirin
  • History of peptic ulcer disease - Caution with using Aspirin, Consult PCP
  • Allergy to Aspirin