Perioperative deep vein thrombosis (DVT) is a significant concern in surgical patients due to the risk of fatal complications such as pulmonary embolism. DVT occurs when a blood clot forms in the deep veins, typically in the lower extremities, and dislodges, leading to serious cardiovascular events. Patients undergoing surgery, especially those involving prolonged immobilization, are at an increased risk. Prevention is essential to mitigate morbidity and mortality associated with perioperative DVT.
Several factors contribute to perioperative DVT risk, including prolonged immobility, endothelial injury, and hypercoagulability. Specific patient-related risk factors include advanced age, obesity, smoking, a history of thromboembolism, malignancy, and inherited thrombophilias. Surgery-related risks include the duration of the procedure, type of surgery (e.g., orthopedic, oncologic, or abdominal), and use of general anesthesia, which may contribute to venous stasis 1–3. Prevention of perioperative DVT targets the modifiable factors among these risk factors.
Pharmacologic prophylaxis remains a cornerstone in the prevention of perioperative DVT. The use of anticoagulants such as low-molecular-weight heparin, unfractionated heparin, and direct oral anticoagulants significantly reduces clot formation. Low-molecular-weight heparin is particularly effective due to its predictable pharmacokinetics and lower risk of heparin-induced thrombocytopenia. The timing and dosing of anticoagulants must be carefully adjusted based on bleeding risk and renal function. In high-risk patients, extended prophylaxis beyond hospital discharge may be necessary, especially after major orthopedic procedures 4,5.
For patients with contraindications to anticoagulation, mechanical prophylaxis provides an alternative approach. Graduated compression stockings and intermittent pneumatic compression devices enhance venous return and reduce stasis in the lower extremities. These devices are particularly beneficial in patients with a high bleeding risk and can be used in conjunction with pharmacologic prophylaxis for maximal effectiveness. Early ambulation should also be encouraged to promote natural circulation and reduce venous stasis 4,6,7.
A multimodal approach combining pharmacologic and mechanical strategies is often the most effective in preventing DVT. Preoperative screening using validated risk assessment models, such as the Caprini Score, allows for tailored prophylaxis strategies based on individual risk profiles. Additionally, intraoperative measures such as maintaining optimal hemodynamics, minimizing operative time, and using regional anesthesia when appropriate may reduce DVT risk. Postoperatively, ensuring adequate hydration, promoting early mobilization, and educating patients about symptoms of DVT are crucial for prevention 4,6.
Certain populations require individualized preventive approaches, like patients undergoing major orthopedic surgeries who likely require a long period of recovery and reduced mobility, cancer patients who face a dual risk of thrombosis due to malignancy-induced hypercoagulability, and pregnant patients undergoing surgery who face an altered coagulation physiology and fetal safety concerns when using anticoagulants. Approaches should be tailored to each patient accordingly 6.
Perioperative DVT prevention requires a combination of pharmacologic and mechanical interventions. Risk stratification, early mobilization, and patient education play vital roles in minimizing complications. As surgical techniques and thromboprophylactic strategies continue to evolve, ongoing research will be necessary to optimize patient outcomes and further reduce the burden of perioperative thromboembolic events.
References
1. McLendon, K., Goyal, A. & Attia, M. Deep Venous Thrombosis Risk Factors. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
2. Stone, J. et al. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovascular Diagnosis and Therapy 7, S276-S27S284 (2017). DOI: 10.21037/cdt.2017.09.01
3. Wu, L. & Cheng, B. Analysis of perioperative risk factors for deep vein thrombosis in patients with femoral and pelvic fractures. J Orthop Surg Res 15, 597 (2020). DOI: 10.1186/s13018-020-02131-5
4. Bartlett, M. A., Mauck, K. F., Stephenson, C. R., Ganesh, R. & Daniels, P. R. Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc 95, 2775–2798 (2020). DOI: 10.1016/j.mayocp.2020.06.015
5. Kwon, S. et al. Perioperative Pharmacologic Prophylaxis for Venous Thromboembolism in Colorectal Surgery. J Am Coll Surg 213, 596-603.e1 (2011). DOI: 10.1016/j.jamcollsurg.2011.07.015
6. Badireddy, M. & Mudipalli, V. R. Deep Venous Thrombosis Prophylaxis. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
7. Godier, A. et al. Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network. Anaesthesia Critical Care & Pain Medicine 101446 (2024) doi:10.1016/j.accpm.2024.101446.