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Rationale for VTE Prophylaxis Recommendations

Many published guidelines for surgical VTE prophylaxis have been published, but the most recent are those produced by ASH (2019 ASH guideline). These guidelines are largely in line with European and other guidelines, with a few subtle differences. One more significant change is that the 2019 ASH guideline does not recommend use of risk stratification tools (Caprini and Rogers scores) for general surgery, while the 2018 NICE guideline do, because of some evidence suggesting that pharmacologic prophylaxis is superior to mechanical prophylaxis and other evidence suggesting any type of prophylaxis is superior to no prophylaxis. Going by these, there is little utility to stratify with such a tool.

For orthopedic surgery, available guidelines include aspirin as an equivalent pharmacologic prophylaxis option, but not as the preferred option. Several studies have shown potential superiority of aspirin in terms of readmissions and bleeding for patients without additional VTE risk factors. At the author’s institution, aspirin has been used for years as a first-line option in patients without contraindications for aspirin or additional VTE risk factors with improved VTE event rates (Azboy et al, Li et al, Rondon et al). Recommendations for surgical oncology patients are based upon the 2023 ASCO Guideline.

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