From the Research
Dual Antiplatelet Therapy (DAPT) is not recommended for Deep Vein Thrombosis (DVT) prophylaxis in patients undergoing Open Reduction Internal Fixation (ORIF) surgery. The standard prophylaxis typically involves either low molecular weight heparin (such as enoxaparin 40mg subcutaneously once daily), fondaparinux, or in some cases, direct oral anticoagulants (DOACs) like rivaroxaban or apixaban, as suggested by 1. Mechanical prophylaxis methods including graduated compression stockings and intermittent pneumatic compression devices are also commonly used, either alone or in combination with pharmacological methods. DAPT, which typically consists of aspirin plus a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel), targets platelet aggregation and is primarily indicated for arterial thrombosis prevention, such as in coronary artery disease or after stent placement, as discussed in 2. DVT, however, is primarily a venous thrombotic condition where fibrin formation plays a more dominant role than platelet aggregation, making anticoagulants more effective than antiplatelet agents for prevention.
Some key points to consider in the management of DVT prophylaxis in ORIF surgery include:
- Patient risk assessment using models like the Caprini score, as mentioned in 1
- The use of pharmacological prophylaxis, such as low molecular weight heparin or fondaparinux, for patients at moderate to high risk of VTE, as recommended in 1
- The consideration of mechanical prophylaxis methods for patients at high risk of bleeding, as suggested in 1
- The importance of individualizing management for patients already on DAPT for another indication, with careful consideration of both bleeding and thrombotic risks, often requiring multidisciplinary consultation between orthopedics, cardiology, and hematology.
It's also worth noting that the use of DAPT in other clinical scenarios, such as coronary artery disease or after stent placement, is well established, as discussed in 2. However, in the context of DVT prophylaxis in ORIF surgery, the evidence suggests that anticoagulants are more effective than antiplatelet agents, as mentioned in 3 and 4. Therefore, DAPT is not the recommended choice for DVT prophylaxis in ORIF surgery, and alternative prophylaxis methods should be considered based on patient risk factors and individual needs.