Table 3. VTE prophylaxis after joint, bone or soft tissue surgery or injuries of the lower extremity^*.

	Pharmacological prophylaxis	Mechancial prophylaxis	Special considerations
Elective total hip replacement	LMWH/fondaparinux/NOAK ↑ ↑	IPC/CS↔	Duration 28–35 days
Fractures close to hip joint and patients undergoing osteotomy	LMWH/fondaparinux ↑ ↑	IPC/CS↔
Elective total knee replacement	LMWH/fondaparinux/NOAK ↑ ↑	IPC/CS↔	Duration 11–14 days
Fractures close to the knee joint and ‧patients undergoing osteotomy	LMWH/fondaparinux ↑ ↑	IPC/CS↔
Contraindications for pharmacological prophylaxis	–	IPC ↑ ↑	Bleeding risk, renal failure
Conservative treatment with joint-spanning cast immobilization	Pharmacological prophylaxis as in surgical patients ↑ ↑	IPC/CS↔	Early functional therapy
Arthroscopy with longer operating time in patients with restricted mobility	LMWH ↑ ↑	–	Special vote of DEGAM: If care provided in family physician practice, individual risk assessment and decision
Bones, ankle joint, foot with immobilizing cast	LMWH ↑	–
Spine (elective surgery)	Individual decision
Spinal injuries	LMWH ↑ ↑	Alternative: IPC ↑	Bleeding risk
Polytrauma	LMWH ↑ ↑	IPC ↑	Bleeding risk, in addition see intensive care recommendations
Pelvic fractures	See fractures close to the hip joint
Burns	With immobilization/additional risk factors LMWH ↑ ↑	↔	When larger areas affected: UFH i.v.

^*Basic measures, if possible with all patients.

↑ ↑, strong recommendation ; ↑, recommendation ; ↔, discretionary recommendation ; LMWH, low–molecular-weight heparin; NOAC, non–vitamin K antagonist oral anticoagulants;

IPC, intermittent pneumatic compression; CS, compression stockings; DEGAM, German College of General Practitioners and Family Physicians; UFH, unfractionated heparin; i.v., intravenous