Pocket ObGyn – Perioperative DVT / PE
See Abbreviations
Definition and Epidemiology
- VTE: DVT & PE are common periop See Chapter 16 for full details on diagnosis and management.
- Rates of postsurgical VTE w/o rx: 29% for benign Gyn & 38% for Gyn oncology
(Br Med J 1978;1:272; Aust N Z J Obstet Gynecol 1983;23:216)
| Perioperative prevention of DVT and PE | ||
| Risk | Pt & Surg | Suggested ppx |
| Low | Minor (<30 min) in pts <40 w/ no additional RF | • Early mobilization |
| Mod | Surg <30 mins w/ RF, Surg >30 min in pts of age 40–60 w/o RF; major Surg in pts <40 w/o RF | • UFH 5000 q12 h or
• LMWH: Dalteparin 2500 QD or enoxaparin 40 QD • or IPCDs or stockings |
| Risk | Pt & Surg | Suggested ppx |
| High | Surg <30 min in pts of age >60 or w/ RF; major Surg in pts >40 w/ RF | • UFH 5000 q8 h or
• LMWH: Dalteparin 5000 QD or enoxaparin 40 QD • &/or IPCD or stockings |
| Highest | Major Surg in pts >60 yo w/ cancer or prior VTE or hypercoagulable state | • UFH 5000 q8 h or
• LMWH: Dalteparin 5000 QD or enoxaparin 40 QD • & IPCDs or stockings • & consider LMWH for 4 w |
| From Use: Obstet Gynecol 2007;110:429; Chest 2008;133:381S; Obstet Gynecol 2012;119:155. | ||