2.8.2.3 Prophylaxis of venous thromboembolism in orthopaedics-specialist use in secondary care only

For specialist use in secondary care only.

For further information, refer to NICE NG89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism .

ChoiceDrugDosage

1st choice oral anticoagulants for VTE in orthopaedic surgery

Apixaban tablets 2.5mg

Dose:
Prophylaxis of venous thromboembolism following knee replacement surgery – 2.5mg twice daily for 10-14 days, starting 12-24 hours after surgery
Prophylaxis of venous thromboembolism following hip replacement surgery, 2.5mg twice daily for 32-38 days, starting 12-24 hours after surgery
Or
Dabigatran capsulesDose:
75mg, 110mgProphylaxis of venous thromboembolism following total hip replacement surgery - 110mg (ELDERLY over 75 years, 75mg) 1-4 hours after surgery, followed by 220mg (ELDERLY over 75 years, 150mg) once daily for 28-35 days, to be taken on the first day after surgery

Prophylaxis of venous thromboembolism following total knee replacement surgery- 110mg (ELDERLY over 75 years, 75mg) 1-4 hours after surgery, followed by 220mg (ELDERLY over 75 years, 150mg) once daily for 10 days, to be taken on the first day after surgery
Or
Rivaroxaban▼ tablets 10mgDose:
10mg once daily, starting 6-10 hours after surgery, provided that haemostasis has been established
5 weeks treatment for hip replacement
2 weeks treatment for knee replacement

Prescribing Notes

Cautions

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