Should Patients with Cancer Undergoing Surgery Receive Perioperative VTE Prophylaxis?

Recommendations • All patients undergoing major surgical intervention for malignant disease should be considered for thromboprophylaxis. • Patients undergoing laparotomy, laparoscopy, or thoracotomy lasting greater than 30 minutes should receive pharmacologic thromboprophylaxis with either low-dose unfractionated heparin (UFH) or LMWH unless contraindicated because of a high risk of bleeding or active bleeding. • Prophylaxis should be commenced preoperatively, or as early as possible in the postoperative period.

• Mechanical methods may be added to pharmacologic methods, but should not be used as monotherapy for VTE prevention unless pharmacologic methods are contraindicated because of active bleeding. • A combined regimen of pharmacologic and mechanical prophylaxis may improve efficacy, especially in the highest-risk patients. • Prophylaxis should be continued for at least 7 to 10 days postoperatively.

Prolonged prophylaxis for up to 4 weeks may be considered in patients undergoing ... more.

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