188.8.131.52 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 .
1st choice oral anticoagulants for VTE in orthopaedic surgery
Apixaban tablets 2.5mg
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
|75mg, 110mg||Prophylaxis 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
|Rivaroxaban▼ tablets 10mg||Dose:|
|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|
- Abixaban, dabigatran and rivaroxaban▼ are approved for specialist use 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 newer oral anticoagulants and the prophylaxis of venous thromboembolism-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
- Dabigatran capsules cannot be crushed or opened and cannot be used in standard compliance aids due to the instability of the drug.
- Refer to BNF for full details of cautions, contraindications and interactions with DOACs.