eMedicine Specialties > Orthopedic Surgery > Systemic Diseases
Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery: Multimedia
Updated: Jun 12, 2009
Multimedia
![]() | Media file 1: Venous thrombus. |
![]() | Media file 2: Pulmonary embolus. |
![]() | Media file 3: Coagulation pathway. |
![]() | Media file 4: Postoperative antithrombin III levels. |
![]() | Media file 5: Antithrombin III levels and deep venous thrombosis formation. |
![]() | Media file 6: Age-adjusted venous thromboembolic risk. |
![]() | Media file 7: Doppler sonogram shows deep venous thrombosis. |
![]() | Media file 8: Venogram shows proximal deep venous thrombosis. |
![]() | Media file 9: Lung scan. |
![]() | Media file 10: Spiral CT scan shows a pulmonary thrombus. |
![]() | Media file 11: Normal pulmonary angiogram. |
![]() | Media file 12: Positive pulmonary angiogram. |
![]() | Media file 13: Comparison of binding sites for standard heparin and low-molecular-weight heparin. |
![]() | Media file 14: Time course of deep venous thrombosis risk. |
More on Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery |
| References |
| Further Reading |
References
Beaty JH, ed. Orthopaedic Knowledge. Rosemont, Ill: AAOS; 1999:63-72.
Warwick D, Williams MH, Bannister GC. Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br. Jan 1995;77(1):6-10. [Medline].
Bergqvist D, Benoni G, Bjorgell O, et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. Sep 5 1996;335(10):696-700. [Medline].
Bergqvist D, Hull RD. Effective thromboprophytaxis administered close to the time of major orthopedic surgery: a review. Am J Orthop. May 2006;35(5):226-30. [Medline].
Kahn SR. Frequency and determinants of the postthrombotic syndrome after venous thromboembolism. Curr Opin Pulm Med. Sep 2006;12(5):299-303. [Medline].
Bani-Hani M, Titi M, Al-Khaffaf H. Deep venous thrombosis after arterial surgery a literature review. Eur J Vasc Endovasc Surg. Sep 4 2008;[Medline].
Freedman KB, Brookenthal KR, Fitzgerald RH Jr, et al. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am. Jul 2000;82-A(7):929-38. [Medline].
Callaghan JJ, Warth LC, Hoballah JJ, et al. Evaluation of deep venous thrombosis prophylaxis in low-risk patients undergoing total knee arthroplasty. J Arthroplasty. Sep 2008;23(6 Suppl 1):20-4. [Medline].
Caprini JA, Arcelus JI, Maksimovic D, et al. Thrombosis prophylaxis in orthopedic surgery: current clinical considerations. J South Orthop Assoc. Winter 2002;11(4):190-6. [Medline].
O'Brien SH, Haley K, Kelleher KJ, et al. Variation in DVT prophylaxis for adolescent trauma patients: a survey of the Society of Trauma Nurses. J Trauma Nurs. Apr-Jun 2008;15(2):53-7. [Medline].
Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part I. Diagnosis. Am Fam Physician. Jun 15 2004;69(12):2829-36. [Medline].
Cosmi B, Palareti G. D-dimer, oral anticoagulation, and venous thromboembolism recurrence. Semin Vasc Med. Nov 2005;5(4):365-70. [Medline].
Katz DS, Hon M. Current DVT imaging. Tech Vasc Interv Radiol. Jun 2004;7(2):55-62. [Medline].
Iskander GA, Nelson RS, Morehouse DL, et al. Incidence and propagation of infrageniculate deep venous thrombosis in trauma patients. J Trauma. Sep 2006;61(3):695-700. [Medline].
Urbankova J, Quiroz R, Kucher N, et al. Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients. Thromb Haemost. Dec 2005;94(6):1181-5. [Medline].
Fisher CG, Blachut PA, Salvian AJ, et al. Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: a prospective, randomized study of compression alone versus no prophylaxis. J Orthop Trauma. Feb 1995;9(1):1-7. [Medline].
[Best Evidence] Camporese G, Bernardi E, Prandoni P, et al. Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med. Jul 15 2008;149(2):73-82. [Medline].
Lachiewicz PF, Kelley SS, Haden LR. Two mechanical devices for prophylaxis of thromboembolism after total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. Nov 2004;86(8):1137-41. [Medline].
Hull RD, Pineo GF. Prophylaxis of deep venous thrombosis and pulmonary embolism. Current recommendations. Med Clin North Am. May 1998;82(3):477-93. [Medline].
Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part II. Treatment and prevention. Am Fam Physician. Jun 15 2004;69(12):2841-8. [Medline].
Verstraete M. Direct thrombin inhibitors: appraisal of the antithrombotic/hemorrhagic balance. Thromb Haemost. Jul 1997;78(1):357-63. [Medline].
Snyder BK. Venous thromboembolic prophylaxis: the use of aspirin. Orthop Nurs. Jul-Aug 2008;27(4):225-30; quiz 231-2. [Medline].
Sors H, Meyer G. Place of aspirin in prophylaxis of venous thromboembolism. Lancet. Apr 15 2000;355(9212):1288-9. [Medline].
Pulmonary Embolism Prevention (PEP) Trial Collaborative Group. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: PEP trial. Lancet. Apr 15 2000;355(9212):1295-302. [Medline].
Berend KR, Lombardi AV Jr. Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty: the role of aspirin. Am J Orthop. Jan 2006;35(1):24-9. [Medline].
Lotke PA, Lonner JH. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res. Nov 2006;452:175-80. [Medline].
McGarray, LJ, Stokes, ME, Thompson, D. Outcomes of Thromboprophylaxis with enoxaparin vs. Unfractionated Heparin in Medical Inpatients: A Retrospective Database Analysis. Thromb J. 2006;Sep 27;4(1):17.
Deitelzweig S, Jaff MR. Medical management of venous thromboembolic disease. Tech Vasc Interv Radiol. Jun 2004;7(2):63-7. [Medline].
Hull RD, Pineo GF, Francis C, et al. Low-molecular-weight heparin prophylaxis using dalteparin extended out- of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a double-blind, randomized comparison. North American Fragmin Trial Investigators. Arch Intern Med. Jul 24 2000;160(14):2208-15. [Medline].
Dranitsaris G, Stumpo C, Smith R, Bartle W. Extended dalteparin prophylaxis for venous thromboembolic events: cost-utility analysis in patients undergoing major orthopedic surgery. Am J Cardiovasc Drugs. 2009;9(1):45-58. [Medline].
Gerotziafas GT, Samama MM. Heterogeneity of synthetic factor Xa inhibitors. Curr Pharm Des. 2005;11(30):3855-76. [Medline].
Bauer KA, Eriksson BI, Lassen MR, et al. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med. Nov 1 2001;345(18):1305-10. [Medline].
Turpie AG, Bauer KA, Eriksson BI, Lassen MR. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med. Sep 9 2002;162(16):1833-40. [Medline].
Turpie AG, Lassen MR, Davidson BL, Bauer KA, Gent M, Kwong LM, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet. May 16 2009;373(9676):1673-80. [Medline].
Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. Jun 26 2008;358(26):2765-75. [Medline].
Lassen MR, Ageno W, Borris LC, Lieberman JR, Rosencher N, Bandel TJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med. Jun 26 2008;358(26):2776-86. [Medline].
Kakkar AK, Brenner B, Dahl OE, Eriksson BI, Mouret P, Muntz J, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet. Jul 5 2008;372(9632):31-9. [Medline].
Keeney JA, Clohisy JC, Curry MC, et al. Efficacy of combined modality prophylaxis including short-duration warfarin to prevent venous thromboembolism after total hip arthroplasty. J Arthroplasty. Jun 2006;21(4):469-75. [Medline].
Kearon C. Epidemiology of venous thromboembolism. Semin Vasc Med. 2001;1(1):7-26. [Medline].
Rosendaal FR. Venous thrombosis: a multicausal disease. Lancet. Apr 3 1999;353(9159):1167-73. [Medline].
Bulger CM, Jacobs C, Patel NH. Epidemiology of acute deep vein thrombosis. Tech Vasc Interv Radiol. Jun 2004;7(2):50-4. [Medline].
Gillies TE, Ruckley CV, Nixon SJ. Still missing the boat with fatal pulmonary embolism. Br J Surg. Oct 1996;83(10):1394-5. [Medline].
Geerts WH, Heit JA, Clagett GP, et al. Prevention of venous thromboembolism. Chest. Jan 2001;119(1 Suppl):132S-175S. [Medline].
Lassen MR, Bauer KA, Eriksson BI, et al. Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison. Lancet. May 18 2002;359(9319):1715-20. [Medline].
Turpie AG, Gallus AS, Hoek JA. A synthetic pentasaccharide for the prevention of deep-vein thrombosis after total hip replacement. N Engl J Med. Mar 1 2001;344(9):619-25. [Medline].
Salvati EA, Pellegrini VD Jr, Sharrock NE, et al. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement. J Bone Joint Surg Am. Feb 2000;82(2):252-70. [Medline].
Muntz JE, Friedman RJ, eds. Case Vignettes: Thromboprophylaxis in Arthroscopic Surgery. Elsevier Excerpta Medica; 2006.
Epstein, NE. Efficacy of Pneumatic Compression Stocking Prophylaxis in the Prevention of DVT and PE Following 139 Lumbar Laminectomies with Instrumented Fusions. J. Spinal Disord Tech. 2006;Feb; 19(1):28-31.
Prevention of thromboembolism in spinal cord injury. Consortium for Spinal Cord Medicine. J Spinal Cord Med. Jul 1997;20(3):259-83. [Medline].
[Best Evidence] Leonardi MJ, McGory ML, Ko CY. The rate of bleeding complications after pharmacologic deep venous thrombosis prophylaxis: a systematic review of 33 randomized controlled trials. Arch Surg. Aug 2006;141(8):790-7; discussion 797-9. [Medline].
Barrett J, Baron JA, Losina E, et al. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg Am. Oct 2006;88(10):2146-51. [Medline].
Miyahara T, Miyata T, Shigematsu K, et al. Clinical outcome and complications of temporary inferior vena cava filter placement. J Vasc Surg. Sep 2006;44(3):620-4. [Medline].
Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. Feb 12 1998;338(7):409-15. [Medline].
Bates SM, Ginsberg JS. Clinical practice. Treatment of deep-vein thrombosis. N Engl J Med. Jul 15 2004;351(3):268-77. [Medline].
Francis CW, Berkowitz SD, Comp PC, et al. Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement. N Engl J Med. Oct 30 2003;349(18):1703-12. [Medline].
Comp PC, Spiro TE, Friedman RJ, et al. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. Enoxaparin Clinical Trial Group. J Bone Joint Surg Am. Mar 2001;83-A(3):336-45. [Medline].
Colwell C, Mouret P. Ximelagatran for the prevention of venous thromboembolism following elective hip or knee replacement surgery. Semin Vasc Med. Aug 2005;5(3):266-75. [Medline].
Boudes PF. The challenges of new drugs benefits and risks analysis: lessons from the ximelagatran FDA Cardiovascular Advisory Committee. Contemp Clin Trials. Oct 2006;27(5):432-40. [Medline].
Schiff RL, Kahn SR, Shrier I, et al. Identifying orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis. Chest. Nov 2005;128(5):3364-71. [Medline].
Further Reading
Related eMedicine topics
Bedside Ultrasonography, Deep Vein Thrombosis
Deep Venous Thrombosis and Thrombophlebitis
Deep Venous Thrombosis, Lower Extremity
Deep Venous Thrombosis, Upper Extremity
Clinical guidelines
Suspected upper extremity deep vein thrombosis (DVT). American College of Radiology. 1995 (revised 2005). 5 pages. NGC:004795
Guidelines for the management of severe traumatic brain injury. Deep vein thrombosis prophylaxis. Brain Trauma Foundation - Disease Specific Society. 2000 (revised 2007). 5 pages. NGC:005773
Venous thromboembolism.
Institute for Clinical Systems Improvement - Private Nonprofit Organization. 1998 Jun (revised 2007 Jun). 91 pages. NGC:005885
Prevention of deep vein thrombosis.
University of Iowa Gerontological Nursing Interventions Research Center, Research Translation and Dissemination Core - Academic Institution. 1999 Jun 10 (revised 2006 Feb). 40 pages. NGC:004960
Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians.
American College of Physicians - Medical Specialty Society. 2007 Feb 6. 8 pages. NGC:005524
Clinical trials
Deep Vein Thrombosis Treatment With the Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients Using a Strong CYP 3A4 Inducer
Selective D-Dimer Testing Compared With Uniform D-Dimer Testing in the Diagnosis of Deep Vein Thrombosis (SELECT)
Residual Vein Thrombosis and the Optimal Duration of Low Molecular Weight Heparin in Cancer Patients With Deep Vein Thrombosis
Prophylaxis Against DVTs After Hip and Knee Surgery
Oral Direct Factor Xa Inhibitor Rivaroxaban In Patients With Acute Symptomatic Deep-Vein Thrombosis Without Symptomatic Pulmonary Embolism: Einstein-DVT Evaluation
Keywords
deep venous thrombosis prophylaxis, deep venous thrombosis, deep vein thrombosis, DVT prophylaxis, pulmonary embolus, pulmonary embolism, PE, venous thromboembolism, VTE, thromboprophylaxis, DVT prevention, PE prevention, VTE prevention, venous stasis, Virchow triad, Virchow's triad, heparin, low-dose heparin, LDH, low-molecular weight heparin, LMWH, unfractionated heparin, UFH, intermittent pneumatic compression, IPC, elastic stockings, ES, post-thrombotic syndrome, postthrombotic syndrome, PTS, heparin-induced thrombocytopenia, HIT



























