Deep venous thrombosis (DVT) is a common cause of morbidity after orthopedic surgery, both in the early post
operative period when pulmonary embolism may complicate in hospital clinical course or occur after discharge and later
due to development of post thrombotic syndrome.
At present, clear evidence has been provided that pharmacological primary prophylaxis of venous thromboembolism
(VTE) is associated with an impressive decrease in the incidence of DVT and related complications. The main limitation
of VTE prophylaxis with anticoagulant drug is the risk of bleeding. Both pharmacological and non pharmacological
measures are available and indication, clinical results and limitations will be discussed for each. For drug prophylaxis at
present mainly are used as parenteral agents, low dose un fractionated heparin, low molecular weight heparin and
fondaparinux; however, limited compliance may be a concern. Newer oral anticoagulants, dabigatran, rivaroxaban and
apixiban, may be indicated in elective surgery in particular in patients with expected poor adherence to parenteral route.
Non pharmacological treatment includes measures directed to decrease the effects of blood stasis, intermittent pneumatic
compression device (IPCD) and graduated compression stockings, mechanical devices, inferior caval vein filters. Aim of
the present review was to suggest practical approach to DVT prophylaxis in patients undergoing major orthopedic
Keywords: Caval filters, dabigatran, doppler ultrasound, enoxaparin, fondaparinux, heparin, orthopedic surgery, prophylaxis,
pulmonary embolism, rivaroxaban, venous thrombosis, warfarin.
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