Thromboprophylaxis after orthopaedic surgery

Abstract

Deep vein thrombosis (DVT) remains a risk for over 40% of patients undergoing major orthopedic and trauma surgeries. It is mainly proximal closures that can lead to fatal pulmonary embolism. Prevention of this complication is part of good clinical practice. We should follow current recommendations (guidelines) of relevant professional organizations for each type of operation with regard to the patient’s individual risk profile. Prophylaxis of thromboembolic disease (TEN) in the knee and hip replacements is necessary either with low molecular weight heparin (LMWH) or with new oral anticoagulants (NOAC). According to the manufacturers, the minimum length of thromboprophylaxis in total replacements of large joints is at least 10-14 days. In clinical practice, administration is prolonged and currently ranges between 4 and 6 weeks (most frequently 35 days) for an uncomplicated patient. It is not recommended to independently use aspirin, dextran, low doses of LMWH, compression stockings or mechanical prophylaxis with a vein-muscle pump device for TEN prophylaxis after total replacements of large joints. Guidelines after major orthopedic surgeries do not mention routine screening with duplex ultrasound prior to discharging from the hospital either.