PREVENTION OF VENOUS THROMBOEMBOLISM IN ORTHOPEDICS IN THE UNITED-STATES

The use of different types of antithrombotic prophylactics in various clinical settings was examined, A standardized questionnaire was maile d to 5000 randomly selected practicing orthopaedic surgeons that detai led practice profile, surgical case type and frequency, method of thro mboembolism prophylaxis used, incidence of morbidity, and type of scre ening used. Twenty-one percent (n = 1046) of surgeons surveyed returne d the questionnaire, Four of 5 surgeons performing elective hip arthro plasty used some form of thromboembolic prophylaxis for all of their p atients, 13% used prophylaxis only for patients considered to be at hi gh risk, and 3% of respondents never used prophylaxis. The rates of pr ophylactic use for patients undergoing elective knee arthroplasty were similar, A considerably lower rate of routine prophylactic use was se en among surgeons performing surgery for pelvic and lower extremity tr auma, Except for cases involving neurologic compromise, most patients undergoing either elective or traumatic spinal surgery were not given prophylaxis, Low dose warfarin alone was the most commonly used prophy laxis modality, A comparison of the results of the current survey with those of past surveys showed that the use of aspirin has fallen, The use of routine pharmacologic prophylaxis against thromboembolism in hi p and knee arthroplasty has become the standard of care in the United States, Among patients undergoing surgery for hip fracture and other l ower extremity trauma, however, prophylaxis remains underused.