[Prevention of venous thromboembolism in orthopaedics].
The incidence of venous thromboembolism in orthopaedic patients is high and its prevention deserves special attention. In patients with total hip and knee replacements and with the proximal femur fractures, low molecular weight heparin should be administered at higher prophylactic dosages. Following its approval, pentasaccharide (fondaparinux) should become the drug of choice, especially in patients with proximal femur fractures. Pharmacological prophylaxis should take at least 10 days in case of total knee replacements and longer in patients with increased risk of venous thromboembolism. In patients with total hip replacements or with proximal femur fractures, LMWH or pentasaccharide prophylaxis is indicated over a period of 28-35 days. Under the conditions of well working infrastructure for anticoagulation treatment, there is an alternative of warfarin treatment, lasting consequently 6-8 weeks. In patients with proximal femur fracture that bleed or are in a very increased risk of bleeding, a possible alternative is represented by intermittent pneumatic compression and shift to antithrombotic treatment after bleeding stops. In patients with knee arthroscopies displaying no risk factors of venous thromboembolism where tourniquet was used no longer than 60 minutes, pharmacological prophylaxis is not necessary. Only timely mobilisation is recommended. In patients displaying risk factors of venous thromboembolism or with tourniquet use surpassing 60 minutes, it is advisable to administer low molecular weight heparin in lower prophylactic dosage. In patients with lower extremity fractures treated with osteosynthesis, LMWH administration of 7-10 days is indicated. In patients with lower extremity injuries requiring plaster casting or other type of fixation reaching below the knee, LMWH administration is indicated over the whole period of fixation in persons with higher risk (people with venous thromboembolism in their histories, in direct relative's histories, people with thrombophilic conditions including poeple with malignancies, women using hormonal contraceptives or their substitutions). Aspirin is not a suitable drug for separate administration in the prophylaxis of venous thromboembolism in orthopaedic patients.
Kessler
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Oddelení hematologie a transfuziologie Nemocnice Pelhrimov. pkessler@hospital-pe.cz
D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005264:Femoral Fractures / Q000601:surgery; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D019637:Orthopedic Procedures; D011134:Polysaccharides / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux