Klin Farmakol Farm. 2017;31(4):9-13 | DOI: 10.36290/far.2017.022

Thromboprophylaxis after orthopaedic surgery

Jiří Lošťák, Jiří Gallo

Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc

Deep vein thrombosis (DVT) remains a risk for over 40% of patients undergoing major orthopedic and trauma surgeries. It is mainlyproximal closures that can lead to fatal pulmonary embolism. Prevention of this complication is part of good clinical practice. Weshould follow current recommendations (guidelines) of relevant professional organizations for each type of operation with regardto the patient’s individual risk profile. Prophylaxis of thromboembolic disease (TEN) in the knee and hip replacements is necessaryeither with low molecular weight heparin (LMWH) or with new oral anticoagulants (NOAC). According to the manufacturers, theminimum length of thromboprophylaxis in total replacements of large joints is at least 10–14 days. In clinical practice, administrationis prolonged and currently ranges between 4 and 6 weeks (most frequently 35 days) for an uncomplicated patient. It isnot recommended to independently use aspirin, dextran, low doses of LMWH, compression stockings or mechanical prophylaxiswith a vein-muscle pump device for TEN prophylaxis after total replacements of large joints. Guidelines after major orthopedicsurgeries do not mention routine screening with duplex ultrasound prior to discharging from the hospital either.

Keywords: total joint replacement (TEP), orthopedic surgery, complications, thromboembolic disease (TEN), deep venous thrombosis
(DVT), low molecular heparin (LMWH), new oral anticoagulans (NOAC)

Published: January 1, 2018  Show citation