Venous Thromboembolism Prevention and Perioperative Management of Anticoagulants

Venous thromboembolism is a common cause of preventable death in surgical patients. Recommendations on the need for VTE prophylaxis as well as management of chronic anticoagulation or bridging anticoagulation during the perioperative period should be based in the patient's thromboembolic and bleeding risks, as well as the surgical risk. Pharmacologic options for VTE prophylaxis and treatment include heparin, vitamin K antagonists, aspirin, and the novel anticoagulants. Timing of cessation and reversal of anticoagulation protocols differ on the agent and its half life. Mechanical compression systems are a useful adjuvant for VTE prevention in high risk patients. Recent ACCP guidelines recommend against use of inferior vena cava filters for prophylaxis.