PREVENTION OF DEEP-VEIN THROMBOSIS IN ORTHOPEDIC-SURGERY AND CONSERVATIVE TREATMENT - A REVIEW OF CURRENT CONCEPTS

Purpose: The necessity of effective prevention of DVT is generally acc epted. However, attitudes and beliefs concerning prophylaxis vary grea tly in terms of the risk groups receiving prophylaxis and the prophyla ctic methodology. This paper reviews current research on the subject a nd seeks to provide recommendations. Results: Known clinical risk fact ors allow the classification of patients according to high, medium and low risk of developing thromboembolism. Basic forms of prophylaxis ar e physiotherapy and early mobilisation. However, there are no data on the safety and efficacy of these methods. Mechanical devices used incl ude external intermittent pneumatic compression and graduated compress ion stockings. Used in isolation, these methods reduce the incidence o f deep vein thrombosis in low and moderate risk patients by one half o r one third. There is no distinction between mechanical and pharmacolo gical methods in terms of safety and efficacy. Furthermore, secondary effects are extremely rare. Moderate and high risk category patients s hould receive combined modes of mechanical and pharmacological treatme nt. A direct comparison of safety in moderate risk patients fixed dose s of standard heparin vs. low molecular weight heparin revealed no sig nificant differences. In the case of high risk patients, adjusted dose heparin administered subcutaneously or fixed dose low molecular hepar in is recommended. A severe secondary effect of heparin-prophylaxis is heparin-induced thrombocytopenie. The optimum duration of pharmacolog ical prophylaxis is not yet clear. Conclusion: The methods and duratio n of prophylaxis remain subject to an individual medical assessment of the clinically significant benefits in relation to the risk secondary effects of the treatment. On major questions there are significant va riations in the specialist literature. This means that standards canno t be formulated, although recommendations can be given.