[Orthopedic patients with or without thrombophilia. Diagnostic, therapy and peri-operative strategies].
Venous thrombosis and pulmonary embolisms are currently associated with high mortality rates in Europe as well as in the United States (mortality rate >300,000-500,000/year). The highest risk is attributed to orthopedic surgery. Besides the use of antithrombotic agents, surgical and anesthesiological procedures as well as a multitude of trigger mechanisms, many thrombophilic risk conditions have to be considered. The incidence of thrombotic complications could be continuously reduced by the improvement of different antithrombotic strategies and use of drugs. According to national and international guidelines low molecular weight heparins and fondaparinux (besides aPTT adjusted strategies by using unfractionated heparin) are mainly indicated in high risk patients undergoing hip and knee surgery.The use of newly developed anti-IIa and anti-Xa inhibitors (e.g. dabigatran etexilate, rivaroxaban) is not yet established in guidelines. The discovery of pentasaccharide has further improved the antithrombotic efficiency, but it is still unknown how to manage patients with thrombophilia. Otherwise the knowledge of thrombophilia is not mandatory to know how to manage high risk patients. In contrast information on a history of thrombotic complications as well as indications gained from the family history are of great importance. Whether and to what extent, which patients with or without thrombophilic disposition, under which conditions from which medication within an anti-coagulation prophylaxis profit most over which time period, will be of future interest. Fundamentally, the age of the patient as well as liver and kidney function values and possible interactions between medications must be taken into consideration for selection of individual anti-thrombotic drugs. Even prolongation of medical immobilization prophylaxis can lead to accumulative risks, such as heparin-induced thrombocytopenia, the risk of which grows with increased exposition to the triggering agent.
Schenk
J F
JF
Institut für Klinische Hämostaseologie und Transfusionsmedizin, Universitätsklinikum des Saarlandes, Kirrberger Strasse 100, 66421, Homburg-Saar, Deutschland. joachim.schenk@uks.eu
Stephan
B
B
Kusma
M
M
Groß
J
J
Eichler
H
H
D002423:Cause of Death; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D019637:Orthopedic Procedures; D010314:Partial Thromboplastin Time; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D012307:Risk Factors; D019851:Thrombophilia / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control / Q000628:therapy
D005343:Fibrinolytic Agents