Prophylaxis of Venous Thromboembolism in Ankle and Foot Surgeries

Zambelli, Roberto; Bastos, Marcos de; Rezende, Suely Meireles

doi:10.1055/s-0040-1715512

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Update Article • Rev. bras. ortop. 56 (06) • Nov-Dec 2021 • https://doi.org/10.1055/s-0040-1715512 copy

Prophylaxis of Venous Thromboembolism in Ankle and Foot Surgeries

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Venous thromboembolism (VTE) is among the most feared complications by orthopedists both for due to its potentially lethal outcome and the uncertainties related to its prevention. Despite the vast literature on VTE prevention in major orthopedic surgeries, little is known about it in ankle and foot procedures. In orthopedics, adequate thromboprophylaxis requires a careful assessment of the thrombotic and hemorrhagic risks based on the procedure to be performed, as well as and knowledge on anticoagulant agents. The presentis review has the goal of assessing the risk of developingdiscusses VTE risk assessment, the modalities of thromboprophylaxis modalities, and the drugs used, with an emphasis on foot and ankle surgeries.

Keywords
thrombosis; orthopedics; surgery; foot; ankle; pre-exposure prophylaxis

Drug	Dose	Time for withdrawal from the preoperative therapy	Notes
Acetylsalicylic acid	100 mg/day, single dose, orally	5 to 10 days before surgery	It should not be used as a monotherapy. Use as extended therapy after 5 days of rivaroxaban in patients with low thrombotic risk
LMWH - enoxaparin	40 mg/day, single dose, subcutaneous	12 hours if low risk of bleeding; 24 hours if high risk of bleeding	Start 12 hours after surgery
LMWH - dalteparin	5,000 IU/day, single dose, subcutaneous	12 hours if low risk of bleeding; 24 hours if high risk of bleeding	Start 12 hours after surgery
LMWH - nadroparin	38 IU of anti-Xa per kilogram of body weight (0.2 to 0.4 mL); increase by 50% on the fourth postoperative day (0.3 to 0.6 mL).	12 hours if low risk of bleeding; 24 hours if high risk of bleeding	Start 12 hours after surgery
Rivaroxaban	10 mg/day, orally	24 hours if low risk of bleeding; 48 hours if moderate or high risk of bleeding, or in elderly patients	Start > 6 hours after surgery
Dabigatran	220 mg/day, orally	48 to 72 hours if normal renal function; minimum of 5 days for major orthopedic surgeries	Start with 110 mg 1 to 4 hours after surgery, followed by 220 mg once a day
Apixaban	2.5 mg orally, twice a day	24 hours if low risk of bleeding; 48 hours if moderate or high risk of bleeding	Start ≥12 hours after surgery
Warfarin	In most cases, 5-10 mg/day, orally	3 to 5 days	After the third day, adjust per INR with a therapeutic target of 1.5 to 2.5. Start 12 to 24 hours after surgery. We suggest a validated warfarin dose-adjustment nomogram

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Roberto Zambelli, PhD, Rua Ouro Preto, 1.016/405, Santo Agostinho, Belo Horizonte, MG, 30.170-041, Brazil (e-mail: zambelliortop@gmail.com).