Dr. Kahue’s recommendations for VTE prophylaxis for patients undergoing surgical procedures include the following:
Assess each patient for VTE risk using the Caprini stratification model.
Apply sequential compression devices to all patients at time of anesthesia induction and all inpatients who are in bed or immobile.
Prescribe unfractionated heparin or low-molecular-weight heparin to any inpatient with a Caprini score of 5-8 or greater (different recommendations exist for which score threshold is better to use).
Consider preoperative pharmacologic prophylaxis for any patient with cancer undergoing surgery (based on ASCO guidelines).
Patients with Mechanical Heart Valves
While mechanical heart valves are becoming rare, Dr. Kahue said her department still performs surgeries on patients with them every few months. “If someone has a mechanical heart valve, they cannot come off anti-coagulation prophylaxis at all because their clot risk is so high,” she said. In this setting, she and her colleagues admit these patients to the hospital, stop their warfarin, and put them on a heparin drip. “You turn that drip off about six hours before surgery, because that’s how quickly that medication is out of the system, do your operation, and start them back on it almost immediately postoperatively,” she said.