Venous thromboembolism prophylaxis and wound healing in patients undergoing major orthopedic surgery.

摘要

Orthopedic surgery carries a high risk for the development of venous thromboembolism (VTE), which can result in deep vein thrombosis (DVT) and/or pulmonary embolism (PE). The absolute risk for DVT in hospitalized patients undergoing hip or knee arthroplasty or hip fracture surgery ranges from 40% to 60%.~1 The incidence of PE is less certain; however, several studies estimate an incidence between 0.9% and 28%. To prevent VTE following total hip replacement, total knee replacement, or hip fracture surgery, evidence-based guidelines of the American College of Chest Physicians recommend anticoagulation prophylaxis.~1 For patients undergoing elective total knee or hip replacement surgery, prophylaxis with low-molecular-weight heparin (LMWH), the factor Xa inhibitor fondaparinux, or a vitamin K antagonist (eg, warfarin) is given the highest grade (grade 1A) of recommendation. Grade lAindi-