Which pharmacologic options are used for DVT prophylaxis after orthopedic surgery?

• A. Aspirin or vitamin K antagonists
• B. Heparin or fondaparinux
• C. Warfarin only
• D. LMWH or DOAC

Answer: (D)

In orthopedic surgery, preventing DVT relies on pharmacologic options that provide reliable anticoagulation with convenient use. The most widely used now are low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs). LMWHs, given by injection, have a long track record of reducing postoperative DVT risk with a predictable dose schedule. DOACs offer effective protection with oral, fixed dosing and no routine lab monitoring, making them especially practical after hip or knee replacements.

Warfarin is less favored for routine postoperative prophylaxis because it takes several days to reach protective levels and requires regular INR monitoring, with dietary and drug interactions that complicate the immediate postoperative period. Aspirin may be used in some low-risk patients, but it is not as consistently protective in high-risk orthopedic cases. Fondaparinux and unfractionated heparin are alternatives in certain situations, but the combination of LMWH or DOACs represents the most commonly used, evidence-based approach.

So, LMWH or DOACs correctly reflect the standard pharmacologic options for DVT prophylaxis after orthopedic surgery.