[Prevention of venous thromboembolism: generally accepted guidelines].
This article summarizes the published data on the prevention of venous thromboembolism. Routine thromboprophylaxis is the best way to lower the risk. It is recommended to sort patients according the thrombosis risk and to make use of the standard prophylactic modes. In low risk patients, no specific thromboprophylaxis is needed. Patients with moderate risk levels are candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression. At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people after major orthopaedic surgeries and with a history of heparin induced thrombocytopenia over the past three months. An alternative to the administration of LMWH even after the end of the hospitalization can be warfarin in certain situations. The sole use of acetylsalicylic acid or Rheodextran is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis.
Gumulec
J
J
Centrum pro trombózu a bemostázu pri Onkologickém centru J. G. Mendla, Nový Jicín. jaromir.gumulec@pr-lab.cz
Penka
M
M
Bezdĕk
R
R
Wróbel
M
M
Kessler
P
P
Brejcha
M
M
Klodová
D
D
Sumná
E
E
Králová
S
S
D000925:Anticoagulants / Q000627:therapeutic use; D001458:Bandages; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D011134:Polysaccharides / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; 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