Postoperative thromboprophylaxis--an orthopedic surgeon's view: is it a valid concept in today's practice?

There are many diverse opinions regarding thromboprophylaxis in orthopedics. Symptomatic events are relatively rare, but the mortality and morbidity rates of patients demand an attempt to reduce the risk. However, the costs and risks of these attempts must be balanced against the efficacy. Until recently, the simplest and most effective chemical prophylactic method has been low molecular weight heparin, which should be continued for at least 5 weeks after surgery. Recent data show that pentasaccharide is more effective. Chemical agents should be used carefully to avoid bleeding into the surgical wound and spinal cord. Mechanical methods, such as the A-V Impulse Foot Pump (Novamedix, Andover, Hampshire, UK), offer a safe and effective alternative, which is attractive in the perioperative period and could be used as an additional method in patients at high risk of thrombosis. In the future, oral antithrombin agents may offer a practical and effective solution to extended duration prophylaxis.