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Prevention of VTE in patients having major orthopedic surgery

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Abstract

Venous thromboembolism (VTE) is a serious risk after major orthopedic surgery (MOS) including total knee replacement, total hip replacement and hip fracture surgery. This risk can be reduced with several pharmacologic and mechanical prophylactic approaches, and the choice among them depends on their ability to reduce VTE with an acceptable increase in adverse events, especially major bleeding complications. Improvements in medical and surgical care have led to a progressive decrease in the risk of VTE after MOS with an estimated baseline risk with contemporary practice of approximately 4.3 % up to day 39 after surgery. Low-molecular-weight heparin is the most thoroughly studied thromboprophylactic agent following MOS and demonstrates good effectiveness with an acceptable rate of bleeding complications. Warfarin, rivaroxaban, dabigatran, and apixaban have all been studied in large trials in comparison with low-molecular-weight heparin and also show an acceptable benefit: risk ratio. Mechanical approaches including graduated compression stockings, intermittent pneumatic compression and venous foot pump also offer protection against VTE, but there is less evidence is available regarding their effectiveness and risks. Combination therapy consisting of an antithrombotic agent and mechanical device is probably more effective than either alone. The appropriate use of thromboprophylaxis after MOS results in reduced VTE with acceptable bleeding risks.

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Conflict of interest

Dr. Francis received compensation from Eisai for participation on a Steering Committee.

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  1. University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box 704, Rochester, NY, 14642, USA

    Charles W. Francis

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Correspondence to Charles W. Francis.

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Francis, C.W. Prevention of VTE in patients having major orthopedic surgery. J Thromb Thrombolysis 35, 359–367 (2013). https://doi.org/10.1007/s11239-013-0889-9

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