Wound pharmacobiology

Wound healing after major joint surgery involves a series of complex events. Over the past several years, thrombin has emerged as a pivotal participant in wound healing. The high incidence of venous thromboembolism following major joint replacement has made prophylaxis with pharmacologic agents a component of postoperative management. Anticoagulant agents of various classes affect different degrees of thrombin inhibition by virtue of their in vivo mechanisms of action. By inhibiting thrombin activity directly, with or without antithrombin III or other antithrombins, traditional anticoagulants may retard the wound healing process and impair completion. Newer, more selective anticoagulants may provide not only more effective alternatives for venous thromboembolism prophylaxis surrounding major orthopedic procedures, but also an anticoagulant environment more favorable to wound healing.