Preventing thromboembolic complications in older orthopaedic surgery patients: interventions and outcomes

The aging of the population in developed countries has been associated with a growing burden of degenerative joint disease and hip fracture, and this has contributed to a progressive increase in the utilisation of major hip and knee arthroplasty. In the absence of effective thromboprophylaxis, patients undergoing major orthopaedic surgery are at high risk of deep vein thrombosis, which may in turn lead to life-threatening complications such as pulmonary embolism, as well as long term sequelae including the post-thrombotic syndrome. However, increasing age is also associated with an increased risk of venous thromboembolism, and older orthopaedic patients are, therefore, at particularly high risk. Randomised trials have demonstrated that the risk of venous thromboembolism in these patients, as demonstrated by venography, can be reduced by more than 50% with the use of effective thromboprophylaxis. However, antithrombotic agents such as low molecular weight heparin and warfarin, which are widely used for the prevention of venous thromboembolism, are also associated with an increased risk of bleeding complications, and selection of the most appropriate strategy should, therefore, involve consideration of the potential risks as well as benefits of the currently available interventions.