Both the American Society of Clinical Oncology and the American Society of Hematology (ASCO and ASH) guidelines recommend that patients with cancer without a history of VTE undergoing a major surgical procedure should be offered pharmacologic prophylaxis with either unfractionated heparin or low molecular weight heparin (LMWH), unless contraindicated because of active bleeding or high bleeding risk. The highest risk period for patients is in the perioperative setting in which they are hospitalized and immobilized.
Recommendations from the International Consensus Meeting – Venous Thromboembolism (ICM-VTE) for Shoulder and Elbow state that VTE prophylaxis should be considered in patients undergoing osteosynthesis who are also at high risk of VTE, and those undergoing surgery under general anesthesia that lasts over 90 minutes. Regarding shoulder arthroplasty, in patients without substantial risk factors for VTE, they do not recommend LMWH or direct oral anticoagulants (DOAC). However, they do not comment on those with substantial risk factors for VTE.
The ICM-VTE for Oncology states that all patients with bone metastases undergoing major surgical intervention should be offered pharmacologic thromboprophylaxis unless contraindicated. They state that larger studies are needed to determine optimal pharmacologic thromboprophylaxis between low molecular weight heparin, direct oral anticoagulants, vitamin K antagonists, and aspirin. These would include large, prospective, randomized studies conducted in collaboration with hematology and medical oncology specialists.