Review article: thromboprophylaxis after total hip replacement.
The risk of secondary haematologic complications such as deep vein thrombosis or pulmonary embolism increases significantly when a transient period of hypercoagulability is induced after total hip replacement (THR). A number of drug-based anticoagulant approaches are available to modulate this risk, but the optimal length of therapy for such approaches remains unclear. The literature was reviewed for evidence-based support of the routine use of an extended course (>14 days) of thromboprophylaxis after THR. Electronic databases and real-time online literature searches were performed, using the PubMed (Medline), EMBASE, CINAHL and GoogleScholar, and the Cochrane and British Medical Journal Clinical Evidence libraries. Author-defined key word searches were performed. Only articles in the English language, for which full text could be retrieved, were reviewed. There is robust evidence to support an extended course (>14 days) of thromboprophylaxis after THR. Such recommendations have been translated into the guidelines of key professional bodies, including those of the American College of Chest Physicians. Meta-review suggests a clear benefit of such regimens and supports wider adoption, even when weighed against a small increase in adverse events.
Kurmis
Andrew P
AP
Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia. andrew.kurmis@mh.org.au
D000925:Anticoagulants / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants