Venous Thromboembolism (Subscribe)  

Antithrombotic Therapy. SIGN Guideline. SIGN Publication No. 36 ISBN 1899893 76 8 Published March 1999

Prophylaxis using heparin and low molecular weight heparin
Heparins and some mechanical pumping devices may help prevent blood clots forming in the legs after surgery for hip fracture
Patients with hip fracture may develop blood clots (thrombosis) in their legs. Some of these blood clots may travel to the lungs and cause...

NEW YORK (Reuters Health) Apr 02 - A review of studies looking at anticoagulant prophylaxis after hip and knee arthroplasty reveals that not only do these agents fail to completely prevent pulmonary embolism (PE), their use may actually increase all-cause mortality. The results, which appear in the March issue of Clinical...

Recently, the first oral direct thrombin inhibitor became available for the prevention of VTE in patients undergoing elective total hip or knee replacement surgery. Dabigatran etexilate (PradaxTM) is a prodrug of dabigatran, a highly specific inhibitor of both clot-bound and free thrombin that can be used in both the hospital...

Clinical Signs for DVT:
- exam may be unreliable but positive findings should not be ignored;
- calf tenderness, swelling, fever, & increased pulse rate may be present
- suggestive exam features for pulmonary embolism:
...

Thrombosis is a naturally occurring physiologic process. Under normal circumstances, a physiologic balance is present between factors that promote and retard coagulation. A disturbance in this equilibrium may result in the coagulation process occurring at an inopportune time or location or in an excessive manor. Alternatively, failure of the normal...

40-60% of THR patients who do not receive prophylaxis will get a DVT (dependment on imaging method);
in contrast, the study by Fender et al (JBJS 1997) showed that the incidence of fatal PE (as diagnosed by postmortem examination) was 4 / 2111 patients (0.19%);
Wheeless' Textbook of Orthopaedics

Routine thromboprophylaxis following elective hip and knee replacement surgery remains a controversial topic. No one disputes that patients undergoing these surgical procedures are at risk for deep vein thrombosis. The combination of stasis, endothelial wall injury and hypercoagulability are almost routine following this type of hip and knee surgery. It...

A randomized trial was performed in consecutive patients undergoing total hip replacement to evaluate the effectiveness of sequential intermittent calf and thigh compression for preventing venous thrombosis compared with a control group given no prophylaxis. Both groups underwent case finding for deep vein thrombosis using combined fibrinogen I 125 leg scanning, impedance plethysmography, and venography....

No guidelines or population-based research exist to guide management for podiatric surgery patients. The objective of our study was to determine the incidence and risk factors for postprocedure VTE in podiatric surgery.
Conclusions: We identified a low overall risk of VTE in podiatric surgery, suggesting that routine prophylaxis is not warranted....

Rationale for Routine Thromboprophylaxis in Major Orthopaedic Surgery
Because venous thromboembolism (VTE) is one of the most common complications following major orthopaedic surgery and is associated with both short- and long-term morbidity and occasional fatal outcome, routine prophylaxis has been the key to reducing the burden of this disease for more...

Rivaroxaban is the first oral direct Factor Xa inhibitor approved in Canada for the prevention of venous thromboembolism (VTE) following elective total hip replacement (THR) and total knee replacement (TKR) surgery. The purpose of this article is to review the available information on rivaroxaban.
Bassam A. Masri, M.D., FRCSC COA...

See links to:
- DVT Discussion
- Pulmonary Embolism
- References
- Role of Dextran in Hip Frx
...

Thromboembolism encompasses two interrelated conditions that are part of the same spectrum, deep venous thrombosis (DVT) and pulmonary embolism (PE). PE is the obstruction of blood flow to one or more arteries of the lung by a thrombus lodged in a pulmonary vessel (see Image 1). PE and DVT can...