Deep vein thrombosis prophylaxis: better living through chemistry--in the affirmative

Venous thromboembolism is a recognized complication of total hip arthroplasty, knee arthroplasty, and hip fracture surgery. Various pharmacological agents have been introduced in orthopedic surgery in an attempt to reduce the mortality as well as the short-term and long-term morbidity associated with the development of deep vein thrombosis and pulmonary embolism. Clinical trials demonstrate the increasing thromboprophylactic efficacy of newer generations of drugs. The most current guidelines of the American College of Chest Physicians regarding thromboprophylaxis after total hip arthroplasty, total knee arthroplasty, and hip fracture surgery give the highest recommendations in support of the use of low-molecular-weight heparin, warfarin, or fondaparinux. Their highest recommendation is also given against the use of aspirin due to its lack of demonstrated efficacy.