General Guideline Principles for Prevention of Venous
Thromboembolic Disease for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Prevention of Venous Thromboembolic Disease.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Prevention of Venous Thromboembolic Disease

Introduction of Prevention of Venous Thromboembolic Disease

Venous thromboembolic disease (VTED) is a complication following hip or knee arthroplasty surgery that can cause morbidity and mortality.

Medications of Prevention of Venous Thromboembolic Disease

1. Low-Molecular Weight Heparin

   Low-Molecular Weight Heparin is recommended – for venous thromboembolic disease prophylaxis.

   Indications: Patients who have undergone post-operative arthroplasty, those with hip fractures, and those who have undergone other significant hip surgery, especially those who have engaged in protracted inactivity or prolonged decreased or sedentary activity levels. Patients who have previously reacted to LMWH should often start with other therapies.

   Frequency/Dose/Duration: There is disagreement over the length of treatment, and it would seem that individualization based on amount of activity is necessary.

   Indications for Discontinuation: the emergence of a serious problem, such significant bleeding, or some negative outcome. Reason: Major bleeding is typically the most serious side effect of the majority of drugs used to stop VTED.

    

2. Xa Inhibitors

   Factor Xa Inhibitors is recommended for venous thromboembolic disease prophylaxis.

   Indications: Post-operative arthroplasty patients, those with hip fractures, or people who had major hip surgery, especially if they had been inactive for a long time or had lowered activity levels. In general, other treatments should come first for those with prior responses. Due to this compound’s renal excretion, patients with renal failure or renal insufficiency should often take a different drug.

    

3. Warfarin and Heparin

   Warfarin and Heparin are recommended Evidence for Factor Xa Inhibitors’ Use

   Indications: patients who have undergone significant hip surgery, hip fracture patients, and post-operative arthroplasty patients.

   Harms: greater potential for bleeding. However, compared to certain other treatment choices, the risk of cerebral and gastrointestinal bleeds is of special concern. The treatment is also more easily reversible than with low molecular weight heparins or Factor Xa inhibitors.

   Frequency/Dose/Duration: Heparin injections administered subcutaneously that can be adjusted for the activated partial thromboplastin time (aPTT). dosage titration of warfarin to the international normalised ratio (INR).

    

4. Aspirin

   Aspirin is recommended in order to prevent deep vein thrombosis.

   Indications: Patients who have undergone postoperative arthroplasty, hip fracture patients, and patients who have undergone other significant hip surgery, typically after stopping other therapies such LMWH, heparin, or other Anticoagulants.

Treatments of Prevention of Venous Thromboembolic Disease

1. Compression Stockings

   Compression Stockings is recommended to stop the disease known as venous thromboembolism.

   Indications: All patients who underwent postoperative hip surgery, including those with hip fractures, hip arthroplasties, or other conditions known to enhance their risk of VTED.

   Indications for Discontinuation: after one month from surgery or if all regular activities and levels of exercise have been resumed. For people who have not started their normal routine again after four weeks, continued use is advised.

    

2. Lower Extremity Pumps

   Lower Extremity Pumps are recommended for venous thromboembolic disease prophylaxis.

   Indications: Patients who underwent major hip surgery afterward (such as those with hip fractures, hip arthroplasties, or any other patients deemed to be at higher risk of VTED in the immediate postoperative period).

   Frequency/Dose/Duration: Devices can be foot pumps, foot pumps with calf pumps, devices that intermittently compress the entire lower leg, or other combinations.

   Indications for Discontinuation:Discontinuation is typically advised after 14 days unless there are persistent problems, such as a delay in rehabilitation or ambulation, that raise concerns about increased risk.

What our office can do if you have Venous Thromboembolic Disease from a workers compensation injury

If you have Venous Thromboembolic Disease from a workers compensation injury, we work with medicine and vascular surgery to treat you. We are orthopedic surgeons and deal with the orthopaedic part of it. We follow a multidisciplinary approach.

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.