PREVENTION OF VENOUS THROMBOEMBOLISM IN MAJOR ORTHOPEDIC-SURGERY

Venous thromboembolism continues to be a major source of morbidity and mortality in both elective and traumatic orthopedic surgery. Preventi on of this complication has received much attention in the orthopedic literature in recent years. We reviewed the relative efficacy and safe ty of various agents in the prophylaxis of venous thromboembolism aris ing after major orthopedic surgery. In patients undergoing total hip r eplacement, low-molecular-weight heparin in fixed doses, adjusted dose s of warfarin, and unfractionated heparin in adjusted doses are the mo st effective prophylactic agents and are highly recommended for routin e use. Low-molecular-weight heparin or warfarin should be used in pati ents with hip fractures. Low-molecular-weight heparin, warfarin, or in termittent pneumatic compression should be used in patients undergoing major knee surgery. A number of questions still remain unanswered. In particular, further studies are needed to establish the optimal durat ion of prophylaxis.