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Table 6 Extended prophylaxis in elderly patients

From: Evaluation of unmet clinical needs in prophylaxis and treatment of venous thromboembolism in at-risk patient groups: pregnancy, elderly and obese patients

QuestionExpert opinionGuideline 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
  1. ACCP/CHEST, American College of Chest Physicians; NICE, The National Institute for Health and Care Excellence; SIGN, Scottish Intercollegiate Guidelines Network; VTE, venous thromboembolism.