Bottner F, Sculco TP, Sharrock NE, Westrich GE, Steinbeck J.
[Prevention of thrombosis in hip prosthesis implantation.]
[Article in German]
Orthopäde 2001 Nov;30(11):890-6

Hospital for Special Surgery, NewYork, NY 10021, USA. boettnerf@hss.edu

Deep venous thrombosis is one of the most common perioperative complications
after total hip arthroplasty. Systemic anticoagulation has been the gold standard
for prophylaxis of postoperative deep venous thrombosis. There is no doubt that
early mobilization and the use of pneumatic compression devices decrease the
overall deep venous thrombosis rate. Single postoperative prophylaxis may
decrease the overall deep venous thrombosis rate to 15-20% and the proximal deep
venous thrombosis rate to approximately 7%. However,the activation of
thrombogenesis is mainly an intraoperative event. The position of the extremity
during the implantation of the femoral component leads to obstruction of the
venous outflow. At the same time, the coagulation cascade is activated and
markers of thrombogenesis in the blood are increased. By combining intraoperative
(hypotensive epidural anesthesia and intraoperative heparin) and postoperative
(pneumatic compression devices and aspirin) prophylaxis of deep venous
thrombosis, the total deep venous thrombosis rate is reduced to less than 10% and
the proximal deep venous thrombosis rate is reduced to 2%. Patients with
increased risk for deep venous thrombosis should receive Coumadin or
low-molecular weight heparin. In addition, hypotensive epidural anesthesia
reduces the intraoperative blood loss and the need for postoperative blood
transfusion.