Perioperative Venous Thromboembolism Prophylaxis in Orthopedic Trauma: A Practical Review.

Background: Orthopedic trauma patients are at high risk for venous thromboembolic (VTE) complications. Despite this, VTE prophylaxis is often held peri-operatively out of concern for increased bleeding and associated complications. This review's purpose is to examine guidelines and studies on withholding prophylactic anticoagulation peri-operatively.

Methods: A narrative review was created using a PubMed systematic literature search with a Boolean approach and these terms: venous thromboembolism, trauma, orthopedic surgery, prophylaxis.

Results: The Western Trauma Association recommends uninterrupted VTE prophylaxis throughout all planned operations, except in very select cases. Most other major trauma and orthopedic societies give no specific recommendations. No current high-quality, randomized control trials investigating this exist; however, emerging studies demonstrate no increased risk of clinically significant hemorrhage when VTE prophylaxis was continued.

Conclusions: There is not compelling evidence or major societal consensus supporting VTE prophylaxis interruption for orthopedic trauma surgery. Therefore, continuation may be safe, potentially reducing patient morbidity.