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Multimodal prophylaxis of venous thrombosis
1Hip and Knee Service, Hospital for Special Surgery, New York, NY 10021, USA.
American Journal of Orthopedics (Belle Mead, N.J.)
|September 28, 2002
Summary
Deep vein thrombosis (DVT) risk after hip replacement surgery has significantly decreased due to improved anesthesia, surgical techniques, and prophylaxis. Advances have led to lower rates of pulmonary embolism, enhancing patient safety post-arthroplasty.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Anesthesiology
Background:
- Deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant postsurgical risks following total hip arthroplasty (THA).
- Historically, reported rates of nonfatal PE ranged from 1.0% to 1.2%, with fatal PE at 0.4% or lower in the late 1980s to early 1990s.
Purpose of the Study:
- To review the declining incidence of thromboembolic disease after THA.
- To identify key advancements contributing to the reduced risk of DVT and PE.
Main Methods:
- Review of literature and clinical practice trends over the past three decades.
- Analysis of factors influencing thromboembolism risk in THA patients.
Main Results:
- Substantial decline in the rates of nonfatal and fatal pulmonary embolism following THA over the last 30 years.
- Recent observations indicate even lower complication rates than previously reported.
Conclusions:
- Improved understanding of DVT pathophysiology, regional anesthesia, surgical techniques, and perioperative prophylaxis have significantly reduced thromboembolic risks.
- Key preventive strategies include autologous blood donation, hypotensive epidural anesthesia, heparin administration, expeditious surgery, pneumatic compression, and early ambulation.