Table 5 Thromboprophylaxis agents approved by the EMA
From: Preventive strategies for hypercoagulation in Cushing’s syndrome: when and how
Agent class | Example | Dose | Comments | Dose adjustment |
|---|---|---|---|---|
LMWH | Enoxaparin | 40 mg sc od | Approved for patients submitted to orthopedic or general surgery and for non-surgical patients with an acute disease and reduced mobility | If GFR < 30 mL/min/1.73 m2, reduce to 20 mg sc od |
Stop 24 h pre-op. | ||||
Start 6 h post-op. | ||||
Factor Xa inhibitor | Fondaparinux | 2.5 mg sc od | Approved for adults submitted to hip or knee surgery and in adults at high risk of VTE who are having abdominal surgery or who are forced to stay in bed | For patients with “kidney problems”, it may not be suitable or the dose of 1.5 mg may be used |
Stop 36-42 h pre-op. | ||||
Start 6 h post-op. | ||||
An alternative to enoxaparin in case of heparin-induced thrombocytopenia | ||||
DOAC* | Rivaroxaban | 10 mg po od | Approved for adult patients submitted to knee or hip arthroplasty | If GFR < 15 mL/min/1.73m2, its use is not recommended |
Stop 48 h pre-op. | ||||
Start 6-10 h post-op. | ||||
Apixaban | 2.5 mg po bid | Approved for adult patients submitted to knee or hip arthroplasty | If GFR < 15 mL/min/1.73m2, its use is not recommended | |
Stop 46 h pre-op. | ||||
Start 12-24 h post-op. | ||||
Dabigatran | 110 mg po in the day of the surgery 220 mg po od thereafter | Approved for adult patients submitted to knee or hip arthroplasty | If GFR 30–50 mL/min/1.73 m2 and age ≥ 75 years, 75 mg po in the day of the surgery and 150 mg po od thereafter | |
Stop 48, 72 and 96 h pre-op. if GFR ≥ 80, 50–80 and 30–50 mL/min/1.73 m2, respectively | ||||
Start 1-4 h post-op. (the dose of 110 mg) |