Why and Who needs it ?

Immobilization after surgery interrupts the venous blood flow and eliminates the calf pumping protective mechanism against clotting

Blood clots from the leg veins may travel to the lungs, causing Pulmonary Embolism, (PE)

PE caries a high risk of death , if untreated

To assess who is at risk for clotting after surgery, we use a scoring system that places you in a low, moderate or high category

For each risk factor, assign a score, based on the following table. Calculate your final score which reflects your risk of blood clots and mandates treatment for blood thinners.

For scores more or equal to 2, start prophylaxis therapy with heparin, coumadin, or the new blood thinners, Xarelto, Eliquis or Pradaxa.

The following get 5 points

• Major, elective lower extremity arthroplasty, Total knee and total hip replacement

• Hip, pelvis, or leg fracture within 1 month

• Stroke within 1 month

• Multiple trauma within 1 month

• Acute spinal cord injury with paralysis within 1 month

The following get 3 points

• Age older than 75 years

• History of DVT or PE

• Family history of thrombosis

• Factor V Leiden/activated protein C resistance

• Medical patient with risk factors of myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease

• Congenital or acquired thrombophilia

The following get 2 point

• Age older than 60 years

• Malignancy or current chemotherapy or radiation therapy

• Major surgery (>45 min)

• Laparoscopic surgery (>45 min)

• Confined to bed longer than 72 hours

• Immobilizing cast shorter than 1 month

• Central venous access for less than 1 month

• Tourniquet time longer than 45 minutes

The following get 1 point

• Age 41-60 years

• Minor surgery

• History of major surgery within 1 month

• Pregnancy or postpartum within 1 month

• Varicose veins

• Inflammatory bowel disease

• Swelling of legs

• Obesity (body mass index [BMI] >25 kg/m 2)

• Oral contraceptives, patch, or hormone replacement therapy