Pauschert R, Diehm C, Stammler F.
[Guidelines for prevention of thrombosis in orthopedics]
Z Orthop Ihre Grenzgeb 1998 Sep-Oct;136(5):471-9

Fachklinik f. Konservative Orthopadie u. Physikal. Medizin, Bad Wimpfen.

PURPOSE: The necessity of effective prevention of DVT is generally accepted.
However, attitudes and beliefs concerning prophylaxis vary greatly in terms of
the risk groups receiving prophylaxis and the prophylactic methodology. This
paper reviews current research on the subject and seeks to provide
recommendations. RESULTS: Known clinical risk factors allow the classification of
patients according to high, medium and low risk of developing thromboembolism.
Basic forms of prophylaxis are physiotherapy and early mobilisation. However,
there are no data on the safety and efficacy of these methods. Mechanical devices
used include external intermittent pneumatic compression and graduated
compression stockings. Used in isolation, these methods reduce the incidence of
deep vein thrombosis in low and moderate risk patients by one half or one third.
There is no distinction between mechanical and pharmacological methods in terms
of safety and efficacy. Furthermore, secondary effects are extremely rare.
Moderate and high risk category patients should receive combined modes of
mechanical and pharmacological treatment. A direct comparison of safety in
moderate risk patients fixed doses of standard heparin vs. low molecular weight
heparin revealed no significant differences. In the case of high risk patients,
adjusted dose heparin administered subcutaneously or fixed dose low molecular
heparin is recommended. A severe secondary effect of heparin-prophylaxis is
heparin-induced thrombocytopenie. The optimum duration of pharmacological
prophylaxis is not yet clear. CONCLUSION: The methods and duration of prophylaxis
remain subject to an individual medical assessment of the clinically significant
benefits in relation to the risk secondary effects of the treatment. On major
questions there are significant variations in the specialist literature. This
means that standards cannot be formulated, although recommendations can be given.