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M O N T H 2 0 1 4 | S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
talized patients, but if patients are up and moving, as mine are, the devices are
largely unnecessary. In the past, patients would be discharged with orders to
take the anticoagulant warfarin for a month, but recent changes to Surgical Care
Improvement Project guidelines permit the prescribing of aspirin, a much safer
and equally effective preventative therapy (see "Aspirin OK for DVT
Prevention").
The protocol we use to control post-op pain is fairly intense in order to get
patients up and moving in recovery. Patients receive localized injections at
the incision site at the time of surgery, and take-home pain pumps are
O R T H O P E D I C S
U
pdated guidelines issued by the
Surgical Care Improvement
Project at the start of this year
added aspirin to the list of acceptable
prophylactic agents for preventing
venous thromboembolism. The addition
solved long-standing confusion and con-
troversy over conflicting recommenda-
tions from the
American Academy of
Orthopaedic Surgeons and
American
College of Chest Physicians, which did
not back the use of aspirin in these
patients.
Here are the SCIP recommendations for
patients undergoing elective total hip or
knee replacement:
•
low-molecular-weight heparin
•
factor Xa inhibitor
•
oral factor Xa inhibitor
•
vitamin K antagonist (warfarin)
•
intermittent pneumatic compression
devices (IPCD)
•
venous foot pump (VFP)
•
low-dose unfractionated heparin (LDUH)
•
aspirin
Surgeons choosing to use aspirin and
mechanical compression as
prophylactic
therapies must note doing so in patients'
charts so concerns about post-op bleed-
ing are clearly documented, according to
Jay R. Lieberman, MD, AAOS's represen-
tative to SCIP.
— Daniel Cook
GUIDELINE REVIEW
Aspirin OK for DVT Prevention
TAKE TWO Aspirin is one of the
recommended
prophylactics
for venous
thromboembolism.
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