[Venous thromboembolism prophylaxis in major orthopaedic surgery: A multicenter, prospective, observational study].
OBJECTIVE
We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS).


METHODS
An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients.


RESULTS
Risk factors for VTE were seen in 73.2% of the patients, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively.


CONCLUSIONS
Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.
Altintaş
Faik
F
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Yeditepe University, Istanbul, Turkey. faltintas@yeditepe.edu.tr
Gürbüz
Hakan
H
Erdemli
Bülent
B
Atilla
Bülent
B
Ustaoğlu
Recep Gür
RG
Oziç
Uğur
U
Savk
Oner
O
Bayram
Hüseyin
H
Memik
Recep
R
Akgün
Işik
I
Göğüş
Abdullah
A
Pestilci
Fatih
F
Konal
Adnan
A
Argün
Mahmut
M
Oztürk
Irfan
I
Dabak
Nevzat
N
Bilgen
Omer Faruk
OF
Serin
Erhan
E
Onder
Cetin
C
Simşek
Aykin
A
Tözün
Remzi
R
Kinik
Hakan
H
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005260:Female; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011134:Polysaccharides / Q000627:therapeutic use; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux