Tromboseprofylaxe in de orthopedische chirurgie: inzichten en onzekerheden

- As it is not always possible to identify patients at extra risk of deep-venous thrombosis after major orthopaedic surgery, it is considered advisable to prescribe prophylactic treatment.

- Prophylaxis with a low dose of unfractionated heparin is more effective than no prophylaxis at all but less effective than low molecular-weight heparin or cumarine derivatives.

- Acetylsalicylic acid does not appear to have a place in the prevention of venous thromboemboli in elective total-hip and total-knee surgery. Its usefulness in the operative treatment of hip fractures has not been established.

- Starting prophylaxis postoperatively has not been shown to be less safe or effective than starting it preoperatively.

- The incidence of thrombosis is lower if the course of prophylactic treatment is lengthened to 4-6 weeks following arthroplasty of the hip or knee. The optimal period of medicinal prophylaxis has yet to be ascertained.

- Intermittent pneumatic compression appears to be effective after total-knee arthroplasty but in practice is difficult to deliver. Support stockings, a foot pump and rapid mobilization have little effect on the incidence of proximal deep-venous thrombosis.

- There are insufficient data regarding the use of thrombosis prophylaxis in day surgery.