, Volume 26, Issue 3, pp 160–170 | Cite as

II consensus intersocietario sulla profilassi antitrombotica in ortopedia e traumatologia

  • F. Biggi
  • F. Randelli
  • E. Romanini
  • G. Danelli
  • G. Della Rocca
  • N. R. Laurora
  • D. Imberti
  • G. Palareti
  • D. Prisco

2nd Italian inter-society consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology


Anticoagulant prophylaxis for preventing VTE is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them is a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the association of Orthopaedic Traumatology of Italian Hospitals (OTODI) together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to foster its clinical application. This statement is therefore addressed to the Italian scientific community and institutions with the aim of attaining good clinical practice in the profession. The present statement will be published in the “Journal of Orthopaedics and Traumatology”,” Lo Scalpello” and in the websites of the Societies participating this consensus (OTODI, SIAARTI, SIMG, SIOT, SISET). It will be submitted to Minerva Anestesiologica.


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  1. 1.
    Falck-Ytter Y, Francis CW, Johanson NA et al; American College of Chest Physicians (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141[2 Suppl.]:e278–325Google Scholar
  2. 2.
    Randelli F, Biggi F, Della Rocca G et al (2011) Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery. J Orthop Traumatol 12:69–76PubMedCrossRefGoogle Scholar
  3. 3.
    Della Rocca G, Biggi F, Grossi P et al (2011) Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery. Minerva Anestesiol 77:1003–1010PubMedGoogle Scholar
  4. 4.
    Biggi F, Randelli F, Della Rocca G et al (2010) Consenso intersocietario sulla profilassi antitrombotica in chirurgia protesica dell’anca e del ginocchio e nelle fratture del collo femorale. Lo Scalpello-OTODI Educational 24(3):206–211CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Romanini E, Tucci G, Zanoli G (2011) La prevenzione del tromboembolismo venoso in chirurgia ortopedica sostitutiva dell’anca e del ginocchio. Linee Guida SIOT. Giornale Italiano di Ortopedia e Traumatologia 37:162–182Google Scholar
  7. 7.
    National Institute for Health and Clinical Excellence (2010) Venous thromboembolism: reducing the risk. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital.
  8. 8.
    Sobieraj DM, Coleman CI, Tongbram V et al (2012) Venous thromboembolism in orthopedic surgery. Comparative effectiveness review no. 49. (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I.) AHRQ Publication No. 12-EHC020-EF. Rockville, MD: Agency for Healthcare Research and Quality (
  9. 9.
    Azu MC, McCormack JE, Scriven RJ et al (2005) Venous thromboembolic events in pediatric trauma patients: is prophylaxis necessary? J Trauma 59:1345–1349PubMedCrossRefGoogle Scholar
  10. 10.
    Candrilli SD, Balkrishnan R, O’Brien SH (2009) Effect of injury severity on the incidence and utilization-related outcomes of venous thromboembolism in pediatric trauma inpatients. Pediatr Crit Care Med 10:554–557PubMedCrossRefGoogle Scholar
  11. 11.
    Hanson SJ, Punzalan RC, Greenup RA et al (2010) Incidence and risk factors for venous thromboembolism in critically ill children after trauma. J Trauma 68:52–56PubMedCrossRefGoogle Scholar
  12. 12.
    Regione Toscana (2011) Linee guida per la profilassi del tromboembolismo venoso nei pazienti ospedalizzati. Doc. 20:30–31 (http://www.salute.toscana. it/sst/consiglio-sanitario-regionale.shtml)Google Scholar
  13. 13.
    Bono CM, Watters WC 3rd, Heggeness MH et al (2009) An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. Spine J 9:1046–1051PubMedCrossRefGoogle Scholar
  14. 14.
    North American Spine Society (2009). Evidence-based clinical guidelines for multidisciplinary spine care. Antithrombotic therapies in spine surgery. NASS, North American Spine Society (
  15. 15.
    Sansone JM, del Rio AM, Anderson PA (2010) The prevalence of and specific risk factors for venous thromboembolic disease following elective spine surgery. J Bone Joint Surg Am 92:304–313PubMedCrossRefGoogle Scholar
  16. 16.
    Zaltz I, Beaulé P, Clohisy J et al (2011) Incidence of deep vein thrombosis and pulmonary embolus following periacetabular osteotomy. J Bone Joint Surg Am 93[Suppl. 2]:62–65PubMedCrossRefGoogle Scholar
  17. 17.
    Struijk-Mulder MC, Ettema HB, Verheyen CC, Büller HR (2010) Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery. J Thromb Haemost 8:678–683PubMedCrossRefGoogle Scholar
  18. 18.
    Testroote M, Stigter W, de Visser DC, Janzing H (2008) Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database Syst Rev (4):CD006681PubMedGoogle Scholar
  19. 19.
    Ettema HB, Kollen BJ, Verheyen CC, Büller HR (2008) Prevention of venous thromboembolism in patients with immobilization of the lower extremities: a meta-analysis of randomized controlled trials. J Thromb Haemost 6:1093–1098PubMedCrossRefGoogle Scholar
  20. 20.
    Bertoletti L, Righini M, Bounameaux H et al; RIETE Investigators (2011) Acute venous thromboembolism after non-major orthopaedic surgery or post-traumatic limb immobilisation. Findings from the RIETE registry. Thromb Haemost 105:739–741PubMedCrossRefGoogle Scholar
  21. 21.
    Wukich DK, Waters DH (2008) Thromboembolism following foot and ankle surgery: a case series and literature review. J Foot Ankle Surg 47:243–249PubMedCrossRefGoogle Scholar
  22. 22.
    Felcher AH, Mularski RA, Mosen DM et al (2009) Incidence and risk factors for venous thromboembolic disease in podiatric surgery. Chest 135:917–922PubMedCrossRefGoogle Scholar
  23. 23.
    Lim W, Wu C (2009) Balancing the risks and benefits of thromboprophylaxis in patients undergoing podiatric surgery. Chest 135:888–890PubMedCrossRefGoogle Scholar
  24. 24.
    Gadgil A, Thomas RH (2007) Current trends in thromboprophylaxis in surgery of the foot and ankle. Foot Ankle Int 28:1069–1073PubMedCrossRefGoogle Scholar
  25. 25.
    Hardy MA (2011) Thromboembolic prophylaxis in foot and ankle surgery: what should we do? Foot Ankle Spec 4:120–123PubMedCrossRefGoogle Scholar
  26. 26.
    Jameson SS, James P, Howcroft DW et al (2011) Venous thromboembolic events are rare after shoulder surgery: analysis of a national database. J Shoulder Elbow Surg 20:764–770PubMedCrossRefGoogle Scholar
  27. 27.
    Lyman S, Sherman S, Carter TI et al (2006) Prevalence and risk factors for symptomatic thromboembolic events after shoulder arthroplasty. Clin Orthop 448:152–156PubMedCrossRefGoogle Scholar
  28. 28.
    Bushnell BD, Anz AW, Bert JM (2008) Venous thromboembolism in lower extremity arthroscopy. Arthroscopy 24:604–611PubMedCrossRefGoogle Scholar
  29. 29.
    Alaia MJ, Zuskov A, Davidovitch RI (2011) Contralateral deep venous thrombosis after hip arthroscopy. Orthopedics 34:e674–677PubMedGoogle Scholar
  30. 30.
    Salvo JP, Troxell CR, Duggan DP (2010) Incidence of venous thromboembolic disease following hip arthroscopy. Orthopedics 33:664PubMedGoogle Scholar
  31. 31.
    Ramos J, Perrotta C, Badariotti G, Berenstein G (2008) Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy. Cochrane Database Syst Rev (4):CD005259PubMedGoogle Scholar
  32. 32.
    Camporese G, Bernardi E, Prandoni P et al; KANT (Knee Arthroscopy Nadroparin Thromboprophylaxis) Study Group (2008) Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med 149:73–82PubMedCrossRefGoogle Scholar
  33. 33.
    Garofalo R, Notarnicola A, Moretti L et al (2010) Deep vein thromboembolism after arthroscopy of the shoulder: two case reports and a review of the literature. BMC Musculoskelet Disord 11:65PubMedCrossRefGoogle Scholar
  34. 34.
    Slobogean GP, Lefaivre KA, Nicolaou S, O’Brien PJ (2009) A systematic review of thromboprophylaxis for pelvic and acetabular fractures. J Orthop Trauma 23:379–384PubMedCrossRefGoogle Scholar
  35. 35.
    Tsiridis E, Gamie Z, George MJ et al (2011) Early postoperative bleeding in polytrauma patients treated with fondaparinux: literature review and institutional experience. Curr Vasc Pharmacol 9:42–47PubMedCrossRefGoogle Scholar
  36. 36.
    Montgomery KD, Geerts WH, Potter HG, Helfet DL (1996) Thromboembolic complications in patients with pelvic trauma. Clin Orthop 329:68–87PubMedCrossRefGoogle Scholar
  37. 37.
    Horner D (2011) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Evidence exists to guide thromboembolic prophylaxis in ambulatory patients with temporary lower limb immobilisation. Emerg Med J 28(8):718–20PubMedCrossRefGoogle Scholar
  38. 38.
    Nokes TJ, Keenan J (2009) Thromboprophylaxis in patients with lower limb immobilisation — review of current status. Br J Haematol 146(4):361–8PubMedCrossRefGoogle Scholar
  39. 39.
    Nurmohamed MT (2007) Thromboprophylaxis is indicated for knee arthroscopy and cast immobilisation. Ned Tijdschr Geneeskd 4;151(31):1730Google Scholar
  40. 40.
    Merli GJ, Martinez J (1987) Prophylaxis for deep vein thrombosis and pulmonary embolism in the surgical patient. Med Clin North Am 71:377–397PubMedGoogle Scholar
  41. 41.
    McKenzie PJ (1991) Deep venous thrombosis and anaesthesia. Br J Anaesth 66:4–7PubMedCrossRefGoogle Scholar
  42. 42.
    Sharrock NE, Haas SB, Hargett MJ et al (1991) Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg Am 73:502–506PubMedGoogle Scholar
  43. 43.
    Nielsen PT, Jørgensen LN, Albrecht-Beste E et al (1990) Lower thrombosis risk with epidural blockade in knee arthroplasty. Acta Orthop Scand 61:29–31PubMedCrossRefGoogle Scholar
  44. 44.
    Leonard SA, Lydon A, Walsh M et al (2001) Does prior administration of enoxaparin influence the effects of levobupivacaine on blood clotting? Assessment using the Thrombelastograph. Br J Anaesth 86:808–813PubMedCrossRefGoogle Scholar
  45. 45.
    Kohrs R, Hoenemann CW, Feirer N, Durieux ME (1999) Bupivacaine inhibits whole blood coagulation in vitro. Reg Anesth Pain Med 24:326–330PubMedGoogle Scholar
  46. 46.
    Siau C, Ng HP, Tan GM et al (2005) In vitro effects of local anaesthetics on the thromboelastographic profile of parturients. Br J Anaesth 94:117–120PubMedCrossRefGoogle Scholar
  47. 47.
    Hahnenkamp K, Theilmeier G, Van Aken HK, Hoenemann CW (2002) The effects of local anesthetics on perioperative coagulation, inflammation and microcirculation. Anesth Analg 94:1441–1447PubMedGoogle Scholar
  48. 48.
    Christopherson R, Beattie C, Frank SM et al (1993) Perioperative morbidity in patients randomized to epidural or general anesthesia for lower-extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 79:422–434Google Scholar
  49. 49.
    Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1493PubMedCrossRefGoogle Scholar
  50. 50.
    Borghi B, Casati A, Iuorio S et al (2005) Effect of different anesthesia techniques on red blood cell endogenous recovery in hip arthroplasty. J Clin Anesth 17:96–101PubMedCrossRefGoogle Scholar
  51. 51.
    Macfarlane AJ, Prasad GA, Chan VW, Brull R (2009) Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth 103:335–345PubMedCrossRefGoogle Scholar
  52. 52.
    Bagry H, de la Cuadra Fontaine JC, Asenjo JF et al (2008) Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg Anesth Pain Med 33:17–23PubMedGoogle Scholar
  53. 53.
    Estebe JP, Davies JM, Richebe P (2011) The pneumatic tourniquet: mechanical, ischemia-reperfusion and systemic effects. Eur J Anaesthesiol 28:404–411PubMedCrossRefGoogle Scholar
  54. 54.
    Kehlet H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62–72PubMedCrossRefGoogle Scholar
  55. 55.
    Chelly JE, Szczodry DM, Neumann KJ (2008) International normalized ratio and prothrombin time values before the removal of a lumbar plexus catheter in patients receiving warfarin after total hip replacement. Br J Anaesth 101:250–254PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • F. Biggi
    • 1
  • F. Randelli
    • 2
  • E. Romanini
    • 3
  • G. Danelli
    • 4
  • G. Della Rocca
    • 5
  • N. R. Laurora
    • 6
  • D. Imberti
    • 7
  • G. Palareti
    • 8
  • D. Prisco
    • 9
  1. 1.UOA Ortopedia e TraumatologiaOspedale S. MartinoBellunoItaly
  2. 2.Dipartimento di Ortopedia e Traumatologia VI.R.C.C.S. Policlinico San DonatoS. Donato Milanese (MI)Italy
  3. 3.Divisione di Ortopedia e TraumatologiaCasa di Cura San FelicianoRomaItaly
  4. 4.U.O. Anestesia Analgesia e Medicina PerioperatoriaAzienda Istituti Ospitalieri di CremonaCremonaItaly
  5. 5.Anestesia e RianimazioneUniversità degli Studi di UdineUdineItaly
  6. 6.UOC Cure PrimarieULSS 12VeneziaItaly
  7. 7.UO di Medicina Interna, Centro Emostasi e TrombosiOspedale Civile di PiacenzaPiacenzaItaly
  8. 8.UO Angiologia e Malattie della CoagulazioneAzienda Ospedaliera Universitaria S. Orsola-MalpighiBolognaItaly
  9. 9.SOD Patologia MedicaAzienda Ospedaliera Universitaria CareggiFirenzeItaly

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