Prevention of venous thromboembolism in the orthopedic surgery patient

Steven B. Deitelzweig, Daniel Brotman, Sylvia C. Mckean, Amir K. Jaffer, Alpesh N. Amin, Alex C. Spyropoulos

Research output: Contribution to journalArticle

Abstract

Patients undergoing major orthopedic surgery-hip or knee arthroplasty, or hip fracture repair-are in the highest risk category for venous thromboembolism (VTE) solely on the basis of the orthopedic procedure itself. Despite this, nearly half of patients undergoing these procedures do not receive appropriate prophylaxis against VTE, often due to a disproportionate fear of bleeding complications in this population. Guidelines from the American College of Chest Physicians (ACCP) provide evidence-based recommendations for many aspects of VTE risk reduction in the setting of orthopedic surgery, as detailed in this review. The ACCP recommends the use of either low-molecularweight heparin (LMWH), fondaparinux, or adjusteddose warfarin as preferred VTE prophylaxis in patients undergoing either hip or knee arthroplasty. Fondaparinux is the preferred recommendation for patients undergoing hip fracture repair, followed by LMWH, unfractionated heparin, and adjusted-dose warfarin as alternative options. Extended-duration prophylaxis (for 4 to 5 weeks) is now recommended for patients undergoing hip arthroplasty or hip fracture repair. Patients undergoing knee arthroscopy do not require routine pharmacologic VTE prophylaxis.

Original languageEnglish (US)
Pages (from-to)27-36
Number of pages10
JournalCleveland Clinic Journal of Medicine
Volume75
Issue numberSUPPL.3
DOIs
StatePublished - 2008
Externally publishedYes

Fingerprint

Venous Thromboembolism
Orthopedics
Hip Fractures
Heparin
Hip
Knee Replacement Arthroplasties
Warfarin
Orthopedic Procedures
Arthroscopy
Risk Reduction Behavior
Arthroplasty
Fear
Knee
Thorax
Guidelines
Hemorrhage
Physicians
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Deitelzweig, S. B., Brotman, D., Mckean, S. C., Jaffer, A. K., Amin, A. N., & Spyropoulos, A. C. (2008). Prevention of venous thromboembolism in the orthopedic surgery patient. Cleveland Clinic Journal of Medicine, 75(SUPPL.3), 27-36. https://doi.org/10.3949/ccjm.75.Suppl_3.S17

Prevention of venous thromboembolism in the orthopedic surgery patient. / Deitelzweig, Steven B.; Brotman, Daniel; Mckean, Sylvia C.; Jaffer, Amir K.; Amin, Alpesh N.; Spyropoulos, Alex C.

In: Cleveland Clinic Journal of Medicine, Vol. 75, No. SUPPL.3, 2008, p. 27-36.

Research output: Contribution to journalArticle

Deitelzweig, SB, Brotman, D, Mckean, SC, Jaffer, AK, Amin, AN & Spyropoulos, AC 2008, 'Prevention of venous thromboembolism in the orthopedic surgery patient', Cleveland Clinic Journal of Medicine, vol. 75, no. SUPPL.3, pp. 27-36. https://doi.org/10.3949/ccjm.75.Suppl_3.S17
Deitelzweig, Steven B. ; Brotman, Daniel ; Mckean, Sylvia C. ; Jaffer, Amir K. ; Amin, Alpesh N. ; Spyropoulos, Alex C. / Prevention of venous thromboembolism in the orthopedic surgery patient. In: Cleveland Clinic Journal of Medicine. 2008 ; Vol. 75, No. SUPPL.3. pp. 27-36.
@article{d16074c92e5b469e87fc47d3d768a1d8,
title = "Prevention of venous thromboembolism in the orthopedic surgery patient",
abstract = "Patients undergoing major orthopedic surgery-hip or knee arthroplasty, or hip fracture repair-are in the highest risk category for venous thromboembolism (VTE) solely on the basis of the orthopedic procedure itself. Despite this, nearly half of patients undergoing these procedures do not receive appropriate prophylaxis against VTE, often due to a disproportionate fear of bleeding complications in this population. Guidelines from the American College of Chest Physicians (ACCP) provide evidence-based recommendations for many aspects of VTE risk reduction in the setting of orthopedic surgery, as detailed in this review. The ACCP recommends the use of either low-molecularweight heparin (LMWH), fondaparinux, or adjusteddose warfarin as preferred VTE prophylaxis in patients undergoing either hip or knee arthroplasty. Fondaparinux is the preferred recommendation for patients undergoing hip fracture repair, followed by LMWH, unfractionated heparin, and adjusted-dose warfarin as alternative options. Extended-duration prophylaxis (for 4 to 5 weeks) is now recommended for patients undergoing hip arthroplasty or hip fracture repair. Patients undergoing knee arthroscopy do not require routine pharmacologic VTE prophylaxis.",
author = "Deitelzweig, {Steven B.} and Daniel Brotman and Mckean, {Sylvia C.} and Jaffer, {Amir K.} and Amin, {Alpesh N.} and Spyropoulos, {Alex C.}",
year = "2008",
doi = "10.3949/ccjm.75.Suppl_3.S17",
language = "English (US)",
volume = "75",
pages = "27--36",
journal = "Cleveland Clinic Journal of Medicine",
issn = "0891-1150",
publisher = "Cleveland Clinic Educational Foundation",
number = "SUPPL.3",

}

TY - JOUR

T1 - Prevention of venous thromboembolism in the orthopedic surgery patient

AU - Deitelzweig, Steven B.

AU - Brotman, Daniel

AU - Mckean, Sylvia C.

AU - Jaffer, Amir K.

AU - Amin, Alpesh N.

AU - Spyropoulos, Alex C.

PY - 2008

Y1 - 2008

N2 - Patients undergoing major orthopedic surgery-hip or knee arthroplasty, or hip fracture repair-are in the highest risk category for venous thromboembolism (VTE) solely on the basis of the orthopedic procedure itself. Despite this, nearly half of patients undergoing these procedures do not receive appropriate prophylaxis against VTE, often due to a disproportionate fear of bleeding complications in this population. Guidelines from the American College of Chest Physicians (ACCP) provide evidence-based recommendations for many aspects of VTE risk reduction in the setting of orthopedic surgery, as detailed in this review. The ACCP recommends the use of either low-molecularweight heparin (LMWH), fondaparinux, or adjusteddose warfarin as preferred VTE prophylaxis in patients undergoing either hip or knee arthroplasty. Fondaparinux is the preferred recommendation for patients undergoing hip fracture repair, followed by LMWH, unfractionated heparin, and adjusted-dose warfarin as alternative options. Extended-duration prophylaxis (for 4 to 5 weeks) is now recommended for patients undergoing hip arthroplasty or hip fracture repair. Patients undergoing knee arthroscopy do not require routine pharmacologic VTE prophylaxis.

AB - Patients undergoing major orthopedic surgery-hip or knee arthroplasty, or hip fracture repair-are in the highest risk category for venous thromboembolism (VTE) solely on the basis of the orthopedic procedure itself. Despite this, nearly half of patients undergoing these procedures do not receive appropriate prophylaxis against VTE, often due to a disproportionate fear of bleeding complications in this population. Guidelines from the American College of Chest Physicians (ACCP) provide evidence-based recommendations for many aspects of VTE risk reduction in the setting of orthopedic surgery, as detailed in this review. The ACCP recommends the use of either low-molecularweight heparin (LMWH), fondaparinux, or adjusteddose warfarin as preferred VTE prophylaxis in patients undergoing either hip or knee arthroplasty. Fondaparinux is the preferred recommendation for patients undergoing hip fracture repair, followed by LMWH, unfractionated heparin, and adjusted-dose warfarin as alternative options. Extended-duration prophylaxis (for 4 to 5 weeks) is now recommended for patients undergoing hip arthroplasty or hip fracture repair. Patients undergoing knee arthroscopy do not require routine pharmacologic VTE prophylaxis.

UR - http://www.scopus.com/inward/record.url?scp=46349095882&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=46349095882&partnerID=8YFLogxK

U2 - 10.3949/ccjm.75.Suppl_3.S17

DO - 10.3949/ccjm.75.Suppl_3.S17

M3 - Article

C2 - 18494224

AN - SCOPUS:46349095882

VL - 75

SP - 27

EP - 36

JO - Cleveland Clinic Journal of Medicine

JF - Cleveland Clinic Journal of Medicine

SN - 0891-1150

IS - SUPPL.3

ER -