The Medical Letter on Drugs and Therapeutics
Prevention of Venous Thromboembolism in Orthopedic Surgery
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Major orthopedic surgery creates a prothrombotic state by causing tissue injury during the operation and requiring relative immobilization during recovery. Without thromboprophylaxis, 40-60% of patients undergoing major knee or hip surgery develop venographically detectable deep vein thrombosis (DVT) and 1 in 300 undergoing total hip replacement will have a symptomatic pulmonary embolism (PE). Thromboprophylaxis reduces the incidence of venous thromboembolism (VTE), but it also can cause bleeding. New guidelines for prevention of VTE have recently been published.1

WARFARIN — The oral vitamin K antagonist warfarin (Coumadin, and others) is widely used for thromboprophylaxis in the US because of its delayed anticoagulant effect, which permits postoperative hemostasis, and the ease of oral administration, particularly after discharge. It is less commonly used in Europe due to its delayed ... more      

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Title: Prevention of Venous Thromboembolism in Orthopedic Surgery
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