Post-discharge prevention of deep vein thrombosis following total joint replacement

Recent prospective studies demonstrate that the peak incidence of deep vein thrombosis (DVT) occurs on the fifth postoperative day. If the patient is to be discharged from an acute care facility on day 3 through 6, then the patient will be removed from direct supervision by professionals-frequently observing the patient in an acute care hospital during the high-risk period for the development of DVT or pulmonary embolism. In addition, the period of vulnerability for the development of thromboembolic disease in this group of patients appears to occur for an extended period of time, eg, 3 months. This change in practice has altered the surgeon's approach to the selection of agents for the prevention of thromboembolic complications. Most surgeons wish to administer an agent in the acute care setting that can be continued after the patient is discharged to the rehabilitation facility, subacute care facility, or home. This information reflects the belief of most orthopedic surgeons that prophylactic therapy should be continued beyond the time frame in which the patient is confined to the acute care facility. Although progress has been made in identifying effective prophylactic agents, questions remain as to the appropriate duration of prophylaxis. Based upon available data, it would appear that prophylaxis against thromboembolic disorders should be continued until the patient is spending the majority of his or her day ambulating with or without external aides.