Extended prophylaxis against venous thromboembolism following total hip and knee replacement

The recently reported reductions in the incidence of post-operative venous thromboembolism (VIE) are related to the widespread use of prophylactic ant icoagulants, Many uncertainties remain with regard to the most effective wa ys to use thromboprophylaxis, however. The trend towards shorter hospital s tays means that patients may receive less than the recommended 7-10 days of prophylaxis. Prolonged periods of thromboprophylaxis may be beneficial for patients at high risk of post-operative VTE, such as those undergoing majo r orthopaedic surgery, The relative rarity of symptomatic deep vein thrombo sis and pulmonary embolism means that very large patient populations are re quired for studies that rely on clinical endpoints, but studies using venog raphic endpoints have shown 28-35 days of prophylaxis with low-molecular-we ight heparin to be more effective than 10-14 days. Other factors that may i nfluence the efficacy of thromboprophylaxis include the timing of the first injection and the choice of agent. Copyright (C) 1999 S. Karger AG, Basel.