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Surgical thromboprophylaxis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

In patients undergoing surgery on hips or knees the risk of deep venous thrombosis (DVT) is 50-70%. In patients not receiving thromboprophylaxis 0.1-0.4% will die from pulmonary embolism.

Anticoagulant thromboprophylaxis treatments include:

  • low-dose unfractionated heparin
  • low-molecular-weight heparin
  • warfarin
  • recombinant hirudin

Despite these treatments 16-30% of hip replacement patients will develop venographically proven DVTs.

The thromboprophylactic dose of low molecular weight heparin is 5000 U twice a day.LMWH reduced the risk of DVT in patients post-total hip replacement by 31-79%. LMWH was as effective as full dose heparin but had a lower incidence of bleeding.

LMWH is also a safe and effective in prevention of DVT in patients undergoing total knee replacement.

Data suggests that a synthetic heparin analogue (fondaparinux) may be superior to LMWH.

Reference:

  • Weitz, JI (1997). Low-molecular-weight heparins. NEJM, 337, 689-698.
  • The Columbus Investigators (1997). Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. NEJM, 337, 657-62.

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