Prevention of venous thromboembolism in the orthopedic surgery patient.
Patients undergoing major orthopedic surgery--hip or knee arthroplasty, or hip fracture repair--are in the highest risk category for venous thromboembolism (VTE) solely on the basis of the orthopedic procedure itself. Despite this, nearly half of patients undergoing these procedures do not receive appropriate prophylaxis against VTE, often due to a disproportionate fear of bleeding complications in this population. Guidelines from the American College of Chest Physicians (ACCP) provide evidence-based recommendations for many aspects of VTE risk reduction in the setting of orthopedic surgery, as detailed in this review. The ACCP recommends the use of either low-molecular-weight heparin (LMWH), fondaparinux, or adjusted-dose warfarin as preferred VTE prophylaxis in patients undergoing either hip or knee arthroplasty. Fondaparinux is the preferred recommendation for patients undergoing hip fracture repair, followed by LMWH, unfractionated heparin, and adjusted-dose warfarin as alternative options. Extended-duration prophylaxis (for 4 to 5 weeks) is now recommended for patients undergoing hip arthroplasty or hip fracture repair. Patients undergoing knee arthroscopy do not require routine pharmacologic VTE prophylaxis.
Deitelzweig
Steven B
SB
Department of Hospital Medicine, Ochsner Health System, New Orleans, LA 70121, USA. sdeitelzweig@ochsner.org
McKean
Sylvia C
SC
Amin
Alpesh N
AN
Brotman
Daniel J
DJ
Jaffer
Amir K
AK
Spyropoulos
Alex C
AC
D000925:Anticoagulants / Q000627:therapeutic use; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011134:Polysaccharides / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D014859:Warfarin; D000077425:Fondaparinux