Thromboembolism prophylaxis in orthopaedics: an update

Overview

This 2018 review in EFORT Open Reviews by Flevas, Megaloikonomos, Dimopoulos, Mitsiokapa, Koulouvaris and Mavrogenis updates the evidence on preventing venous thromboembolism (VTE) in orthopaedic patients. It describes VTE as a serious but largely preventable cause of in-hospital death, and orthopaedic surgery as one of the highest-risk settings.

Who it is for

Orthopaedic and trauma surgeons, anaesthetists, hospitalists, haematologists, pharmacists and nurses responsible for thromboprophylaxis protocols on surgical wards.

Key areas covered

The review explains why orthopaedic surgery combines all elements of Virchow's triad: venous stasis from immobilisation and tourniquet use, endothelial injury from surgical manipulation, and hypercoagulability after trauma. It contrasts the burden of VTE with and without routine prophylaxis and notes wide variation in prophylaxis use between institutions and countries. Prevention methods are grouped into mechanical options, such as early mobilisation, compression stockings, intermittent pneumatic compression and foot pumps, and the main pharmacological classes of anticoagulant and antiplatelet agents.

Notable emphasis

The authors compare the relative effectiveness of the pharmacological options and state their scepticism about relying on antiplatelet therapy alone after hip and knee replacement or hip fracture surgery. They identify knee arthroscopy, lower leg injuries and upper limb surgery as areas where the need for routine prophylaxis remains controversial.

How to use this guideline

The article summarises the evidence landscape. It does not replace current society guidance. Readers should consult the full text and up-to-date national recommendations for agent selection, dosing and duration.