Thromboprophylaxis in hip arthroplasty. New frontiers and future strategy

Abstract

Coagulation-related complications are a frequent cause of death following hip replacement surgery. Venographically-proven deep vein thrombosis (DVT) is found in a high frequency. Most cases have no symptoms. Fatal pulmonary embolism (PE) may develop from subclinical thrombi. In addition, arterial thromboses may induce serious cardiovascular events and an unknown number of patients may develop cardiorespiratory insufficiency, due to non-fatal venous PE. Finally, several patients may develop venous insufficiency. Recent prospective double-blind studies have shown that the frequency of deep vein thrombosis increased after hospital discharge in patients undergoing hip replacement surgery. Prolonged thrombo-prophylaxis with low-molecular-weight heparin (dalteparin or enoxaparin) is recommended for at least 5 weeks after the operation.