Table 6 Extended prophylaxis in elderly patients
Question | Expert opinion | Guideline recommendations |
|---|---|---|
Should extended prophylaxis be used in elderly patients, e.g., for hip fractures? | • In patients with cancer • In patients undergoing surgery • Hip/knee replacements • In patients with multiple fractures at risk of recurrent VTE • Injections can only be used for 2 weeks, oral is the preferred treatment • Generally given for 10–14 days but can be extended to 30–35 days • Primary prophylaxis is currently recommended for 35 days • Recommended for 1 month but often extended for 3 months • This should only be for very high-risk patients but we don’t know how to identify them • Yes, but length of time is not well defined | All recommendations are non-age specific. ACCP/CHEST [28]: • Extended-duration thromboprophylaxis up to 35 days reduces VTE in hip replacement, hip fracture and abdominal malignancy surgery NICE [38]: • There is a recommendation for research by the NICE guideline committee regarding extended-duration prophylaxis for patients undergoing elective total hip replacement surgery SIGN [39]: • Following total hip replacement, particularly those with previous VTE |