title: [Advances and perspectives in the prevention of venous thromboembolic disease].
abstract: The prevention of thrombo-embolic disease, the 3rd commonest cause of death, has made very great progress since the advent of low molecular weight heparins (LMWH) because the large number of clinical studies and consensus meetings have progressively refined the recommendations relating to their use with a variable level of evidence (1 or 2 A, B, C, or C+). Post-operative TE accidents have a multifactorial origin, involving factors inherent to the patients, environmental ones, and those relating to the type of surgical intervention. Major orthopaedic surgery, total hip replacement (THR), and total knee replacement (TKR) have benefitted from a greater number of clinical studies. The debate remains open concerning the timing of the first pre- or post-operative injection, and about taking into account the use or not of a regional anaesthetic. The duration of prophylactic treatment after THR remains under discussion between 10-14 days and 30 days, at least systematically after operation, or only in patients at high risk? Aspirin is not indicated due to its reduced and significantly inferior efficacity compared to heparins. In general medicine, well-defined groups, myocardial infarction, cerebral vascular accidents with immobilisation merit a prophylactic treatment (1A). In the acute phase of severe cardiac, pulmonary or infectious diseases prophylaxis is justified even if this recommendation (1A) is not regularly observed.
authors.affiliation: L'Hôtel-Dieu, Paris.
authors.forename: M M
authors.initials: MM
authors.lastname: Samama
mesh_terms: D000765:Anesthesia, Conduction; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D020246:Venous Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin