[Indications for out-of-hospital thromboprophylaxis]

In the last decade the performance of an adequate perioperative prophylaxis for venous thromboembolism (VTE) has become an established in-hospital measure. Although new antithrombotic drugs (oral thrombin inhibitors, fondaparinux) could reduce the incidence of perioperative VTE the absolute number remains high. In contrast to the widely accepted in-hospital perioperative prophylaxis, it is still unclear whether prophylaxis has to be prolonged after the hospital stay ("out-of-hospital prophylaxis"). In this review we will demonstrate by evaluation of recent studies and recommendations that a prolonged out-of-hospital prophylaxis for venous thromboembolism can further reduce the incidence of VTE after surgery, mainly orthopaedic surgery, e.g. endoprothetic joint replacement. At present low molecular weight heparins (LMWH) may be most effective and exhibit a low risk for major bleeding. Similar studies with other antithrombotics and other types of surgery are still missing. Finally the medico-legal aspects concerning postoperative in-hospital and extended prophylaxis are discussed.