Thromboprophylaxis in orthopedic surgery: how long is long enough?
Pharmacologic thromboprophylaxis with low-molecular-weight heparins, vitamin K antagonists, or fondaparinux is well tolerated and effective in preventing venous thromboembolism (VTE) in major orthopedic surgery but is often limited to in-hospital use. However, 45% to 80% of all symptomatic VTE events occur after hospital discharge. Extended-duration VTE prophylaxis for 28 to 35 days reduces risk for late VTE by up to 70%. In this article, I review the evidence supporting guideline recommendations regarding extended-duration prophylaxis after major orthopedic surgery and provide an overview of current and emerging literature regarding prevention of postoperative VTE in patients undergoing this surgery.
Muntz
James
J
Baylor College of Medicine, Houston, Texas 77030, USA. jmuntz@tmhs.org
D000925:Anticoagulants / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D015201:Meta-Analysis as Topic; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants