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Thromboembolism in Orthopedic Surgery: Scope of the Problem

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Thromboembolism in Orthopedic Surgery

Abstract

Major surgery or traumas of the lower extremities trigger the coagulation cascade, and the physiologic equilibrium between factors promoting and retarding coagulation is disturbed resulting in a hypercoagulable state. In these patients, a reduced venous flow and impaired endothelial function further increase the risk of developing deep-vein thrombosis and pulmonary embolism. Pulmonary embolism is estimated to contribute to half of all perioperative mortality after major orthopedic surgery in unprotected patients, and deep-vein thrombosis is the main source of pulmonary emboli.

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References

  1. Collins R, Scrimgeour A, Yusuf S, et al. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopedic, and urology surgery. N Engl J Med. 1988;318:1162–73.

    Article  PubMed  CAS  Google Scholar 

  2. Sevitt S, Gallagher NG. Prevention of venous thrombosis and pulmonary embolism in injured patients: a trial of anticoagulant prophylaxis with phenindione in middle-aged and elderly patients with fractured necks of femur. Lancet. 1959;2:981–9.

    Article  PubMed  CAS  Google Scholar 

  3. Johnson R, Green JR, Charnley J. Pulmonary embolism and its prophylaxis following the Charnley total hip replacement. Clin Orthop Relat Res. 1977;127:123–32.

    PubMed  Google Scholar 

  4. Anonymous. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial coordinated by Kakkar VV, Corrigan TP and Fossard DP. Lancet. 1975;2(7924):45–51.

    Google Scholar 

  5. Kakkar VV, Corrigan TP, Fossard DP, et al. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Reappraisal of results of international multicentre trial. Lancet. 1977;1(8011):567–9.

    PubMed  CAS  Google Scholar 

  6. Kline A, Hughes LE, Campbell H, et al. Dextran 70 in prophylaxis of thromboembolic disease after surgery: a clinically oriented randomized double-blind trial. BMJ. 1975;2:109–12.

    Article  PubMed  CAS  Google Scholar 

  7. van Ooijen B. Subcutaneous heparin and postoperative wound hematomas: a prospective, double-blind, randomised study. Arch Surg. 1986;121:937–40.

    Article  PubMed  Google Scholar 

  8. Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients: results of meta-analysis. Ann Surg. 1988;208:227–40.

    Article  PubMed  CAS  Google Scholar 

  9. Nurmohamed MT, Rosendaal FR, Buller HR, et al. Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet. 1992;340:152–6.

    Article  PubMed  CAS  Google Scholar 

  10. Kakkar VV, Cohen AT, Edmonson RA, et al. Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery. Lancet. 1993;341:259–65.

    Article  PubMed  CAS  Google Scholar 

  11. Jorgensen LN, Wille-Jorgensen P, Hauch O. Prophylaxis of postoperative thromboembolism with low molecular weight heparins. Br J Surg. 1993;80:689–704.

    Article  PubMed  CAS  Google Scholar 

  12. Thomas DP. Does low molecular weight heparin cause less bleeding? Thromb Haemost. 1997;78:1422–5.

    PubMed  CAS  Google Scholar 

  13. Koch A, Ziegler S, Breitschwerdt H, et al. Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis: meta-analysis based on original patient data. Thromb Res. 2001;102:295–309.

    Article  PubMed  CAS  Google Scholar 

  14. Turpie AG, Levine MN, Hirsh J, et al. A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986;315(15):925–9.

    Article  PubMed  CAS  Google Scholar 

  15. Bergqvist D, Mätzsch T, Burmark US, et al. Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis. Br J Surg. 1988;75(9):888–91.

    Article  PubMed  CAS  Google Scholar 

  16. Eriksson BI, Zachrisson BE, Teger-Nilsson AC, et al. Thrombosis prophylaxis with low molecular weight heparin in total hip replacement. Br J Surg. 1988;75(11):1053–7.

    Article  PubMed  CAS  Google Scholar 

  17. Monreal M, Lafoz E, Olive A, et al. Comparison of subcutaneous unfractionated heparin with a low molecular weight heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin. Thromb Haemost. 1994;71:7–11.

    PubMed  CAS  Google Scholar 

  18. European Medicines Agency. Fondaparinux summary of product characteristics. 2007. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR__Product_Information/human/000403/WC500027746.pdf. Accessed 16 Sep 2010.

  19. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism. Chest. 2008;133:381S–453.

    Article  PubMed  CAS  Google Scholar 

  20. Warwick D, Harrison J, Glew D, et al. Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein-thrombosis after total hip replacement. A prospective randomized trial. J Bone Joint Surg Am. 1998;80:1158–86.

    PubMed  CAS  Google Scholar 

  21. Schellong SM, Beyer J, Kakkar AK, et al. Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study. J Thromb Haemost. 2007;5:1431–7.

    Article  PubMed  CAS  Google Scholar 

  22. Eikelboom JW, Quinlan DJ, Douketis JD. Extended duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet. 2001;358:9–15.

    Article  PubMed  CAS  Google Scholar 

  23. Hull RD, Pineo GF, Stein PD, et al. Extended out-of hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann Intern Med. 2001;135:858–69.

    PubMed  CAS  Google Scholar 

  24. Cohen AT, Bailey CS, Alikhan R, et al. Extended thromboprophylaxis with low molecular weight heparin reduces symptomatic venous thromboembolism following lower limb arthroplasty: a meta-analysis. Thromb Haemost. 2001;85:940–1.

    PubMed  CAS  Google Scholar 

  25. Quinlan DJ, Eikelboom JW, Dahl OE, et al. Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery. J Thromb Haemost. 2007;5:1438–43.

    Article  PubMed  CAS  Google Scholar 

  26. Scurr JH, et al. Deep venous thrombosis: a continuing problem. BMJ. 1988;297(6640):28.

    Article  PubMed  CAS  Google Scholar 

  27. Planes A, Vochelle N, Darmon JY, et al. Risk of deep-venous thrombosis after discharge in patients having undergone total hip replacement; double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996;348:224–8.

    Article  PubMed  CAS  Google Scholar 

  28. Bergqvist D, Benoni G, Bjørgell O, et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996;5:696–700.

    Article  Google Scholar 

  29. Dahl OE, et al. Prolonged thromboprophylaxis following hip replacement surgery;-results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin). Thromb Haemost. 1997;77:26–31.

    PubMed  CAS  Google Scholar 

  30. Lassen MR, Borris LC, Anderson BS, et al. Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty the Danish Prolonged Prophylaxis (DaPP) Study. Thromb Res. 1998;89:281–7.

    Article  PubMed  CAS  Google Scholar 

  31. Comp PC, Spiro TE, Friedman RJ, et al. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. J Bone Joint Surg Am. 2001;83:336–45.

    PubMed  Google Scholar 

  32. Dahl OE, Quinlan DJ, Eikelboom J, et al. A critical appraisal of bleeding events reported in venous thromboembolism prevention trials of patients undergoing hip and knee arthroplasty. J Thromb Haemost. 2010;8:1966–75.

    Article  PubMed  CAS  Google Scholar 

  33. Bjørnarå BT, Gudmundsen TE, Dahl OE. Frequency and timing of clinical venous thromboembolism after major joint surgery. J Bone Joint Surg Br. 2006;88(3):386–91.

    Article  PubMed  Google Scholar 

  34. Prandoni P, Villalta S, Bagatella P, et al. The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients. Haematologica. 1997;82:423–8.

    PubMed  CAS  Google Scholar 

  35. Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257–64.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Bengt I. Eriksson M.D., Ph.D. .

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Eriksson, B.I., Dahl, O.E. (2013). Thromboembolism in Orthopedic Surgery: Scope of the Problem. In: Llau, J. (eds) Thromboembolism in Orthopedic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4336-9_1

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  • DOI: https://doi.org/10.1007/978-1-4471-4336-9_1

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