2.8.2.3 Prophylaxis of venous thromboembolism in orthopaedics

*Specialist initiation in secondary care only*


Choice	Drug
1st choice oral anticoagulant for VTE in orthopaedic surgery	Apixaban tablets 2.5mg
2nd choices	Dabigatran capsules 75mg, 110mg
	Or
		Rivaroxaban tablets 10mg (note: rivaroxaban capsules are high cost)

Refer to NICE NG89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism.
Apixaban, dabigatran and rivaroxaban are approved for specialist initiation only, in hip and knee replacement surgery, for prophylaxis of venous thromboembolism.
NICE have issued a number of pieces of guidance in relation to the DOACs and the prophylaxis of venous thromboembolism – these are listed below for information:
- NICE TA 157 (September 2008) Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee surgery in adults
- NICE TA 170 (April 2009) Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
- NICE TA 245 (January 2012) Apixaban for the prevention of venous thromboembolism after total hip or knee replacements in adults.

Cautions

Refer to BNF for full details of cautions, contraindications and interactions with DOACs