{"text":"It is the responsibility of the consultant\u2019 \n.\u201d the patient specific VTE prophylaxis instruction sheet. Contra-in \n* observed = if in.doubt discuss directly with consultant\u2019s team. \n. \nThromboproptiylaxis on Admission B \n1 \nin.chargeto decide.on the appropriate VTE prophylaxis. Follow reqqrh\u2019mendations recorded in. \ndications or-drug interactions with any of these agents'must be \n\u2018 Reduce dose.to.20mgq if eGFR <30ml\/min or if patient weights <50Kg . \n. Procedure - s During admission . . . \n\u00ab Hip fracture Standard VTE risk | Enoxaparin.SC 40mg once daily started on the day of surgery at 6pm or at \n* Lower limb fractures . | least 4 hours after surgery, whichever is latest \n& Total hip replacement | Reduce dose to 20mg if eGFR < 30mi\/min.or if patient weights <50Kg \n+ Othermajor ) L \u2018 . . . \u2019 \nelective surgery Increased VTE Enoxaparin SC 40mg once daily started.on the day of surgery at 6pm.or at, - \nto lower limbs risk | teast 4 hours after surgery, whichever is-latest . \nReduce doseto 20mg if \u20acGFR <30mi\/min or if patient weights <50Kg \nTotal knee replacement | standard VTE risk | Aspirin drally 150mg daily . \no Oor . * : . s \n. | Enoxaparin SC 40mg once daily started on the day:of surgery at 6pm or at \n\u2019 - - least 4 'hours after surgery, whichever is latest . s \ni \u2018 Reduce dose to 20mg if eGFR <30mi\/min or'if patient weights <50Kg \n. Increased VTE Enoxaparin SC 40mg\u2019once. daily started on the day of 'surgery at 6pm or at \nrisk _least 4 hours after surgery, whichever is latest - : \n\"Rivaroxaban (under consultant advice-only) \nfollowing total hip or total knee r\u00e9placement ~in \nCheck BNF for advice on dose and duration:of treatment. Discuss arrangei \nrivaroxaban. Note that rivaroxaban is licensed.for orthopaedics thrfzmbaprophylaxis only after elective hip or knee replacement and its \n~ Asmall proportion of patients may:requir\u00e9 thromboprophylaxis with rivaroxaban \nthese cases follow orthopaedic and\/or haematology consultant recommendations. \nments with clinical pharmagist if patient is to be discharged on \nuse following.an.initial course of enoxaparin Is off-label. . \nOther elective surgery (including | Standard VIE risk' | No need for pharmacological; thromboprophylaxis \n| upper limb, arthroscopy and Increased VTE Follow recommendations from.orthopaedic:and\/or' haematology consultant \nforefoot surgery) risk \u00b0 \" : \n. | Elective spinal surgery Thromboprophylaxis assessment done on a case-by-case basis dependirig-on the type of surgery \nand risk factors \u2014 follow recommendations.from_spinal surgeon. i : \nMuitiple Trauma Thromboprophylaxis assessment done on a case-by-case basis depending on.ttie extent of \ninjuries \u2014 follow recommendations from orthopaedic and\/or haematology consultant \nSpinal cord injury \nfollow recommendations from the spinal injuries team \n| Thromboprophylaxis assessment done on a case-by-case basis depending on the type of injury \u2014 \nOrthopaedic pati\u00e9nts who do not - \nrequire surgery \nFollow thromboprophylaxis guideline in the Therapeutics Handbook \nThromboprophylaxis on Dlscharge \n\" o Total knee replacement \n- '| Procedure . \u2018On discharge\u2019 . : - 7 : \n\u00bb \u201cHip fracture Standard VTE risk- | Continue endxaparin SC for an overall treatment course of 2 weeks or until \n. _ | discharge:(whichever is sooner) i , : . \n| Increased VTE - Continue enoxaparin SC for-an overall treatment course'of 5 weeks\u00a5 \n. risk . - .. . ' \n+ Lower limb fractures ~ | Standard VTE risk | Aspirin orally 150mg daily for'5 weeks \n\u00ab Total hip replacement ' A - \n* g:?:;:v\"a\u2019or elective Increased VTE \u201cContinue enoxaparin SC for an: overall treatment course of 5 weeks* ' \nTo lower limbs \"} ns!< o \n| Rivaroxaban (under.consultant advice only) \nfollowing total hip or total knee replacement \u2014 \nCheck BNF for advice on dose and duration of \nrivaroxaban. Note that rivaroxaban is licensed for orthopaedics thromboprophyi. \n7 A small proportionof patients' may require thromboprophylaxis with rivaroxaban \nin these cases follow orthopaedic and\/or haematology consultant recommendations. \ntreatment. Discuss arrangements with clinical pharmacist if patient is to be discharged on \nlaxis.only after elective hip or knee replacement and its \nuse following an initial course.of \u00e9noxaparin is off-label. \nOther elective surgery (including | Standard VTE risk | No need for pharmacolodical; thromboprophylaxis . \nupper limb, arthroscopy and Increased VTE Follow recommendations from orthopaedic and\/or haematology consultant \nforefoot surgery) : risk ) . i \nElective spinal surgery \nThramboprophylaxis assessment done on a.ca \nse-by-\"i:ase basis depending on \nand risk factors \u2014 follow recommendations from spirial surgeon \nthe type of surgery \nMuitiple Trauma \nThromboprophylaxis assessment dane on a case-by-case basis:depending on the extent-of - \ninjuries \u2014 follow.recommendations from orthopaedic and\/or haematology \u00a2onsultant \u00a2 \nSpinal cord injury \nThromboprophylaxis assessment done on-a case-by-case basis dependi \n' follow recommendations from the spinal injuries team ) \nOrthdpaedic patienis who do not \n. require surgery \nFollow thromboprophylaxis guideline in.the Therapeutics Handboo! \nng on the type of injury \u2014. \n*Arrarigements for the supply and administration. of ehoxaparin after d]\u00e9charge-arefcu \n* pharmacist-for information on local arrangements in your hospital. \nVTE:RAT Orttio V.14 10\/03\/14 \n1 \n- \n. \nrr\u00e9ntly under- discussion. with Primary Care. Contact' clinical \nThromboprophylaxis Guidelines for Orthopaedic Patients 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