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When to start venous thromboembolism prevention in surgery
Vol. 65, Suppl. 1
ABSTRACTS OF 12TH INTNAT’L CONGRESS
s21
S38 PREVENTION OF DEEP VEIN THROMBOSIS IN ORTHOPEDIC SURGERY A. Planes, N. Vochelle, M. Fagola Clinique Radio-Chirurgicale du Mail, La Rochelle, F In our presentation we will address some of the main questions raised in the prevention of deep vein thrombosis (DVT) in orthopedic surgery. We will describe them, and when possible, try to give an answer. These questions are: 1* What is the natural history of DVT and pulmonary embolism in various orthopedic situations? 2p What the methods of prophylaxis are used and what is their efficacy? 3* What is the best strategy to prevent fatal PE? 4* What modification of the natural history of DVT is induced by an effective prophylaxis? 5* What is the cost-effectiveness of prophylaxis? 6* What axe the new difficult, unanswered questions?
s39
when to start venousthromboembolismprevention in sutgery. D Bergqvist - Sweden To start prophylaxis in order to have it functioning during the operation has undoubtedly been effective from a prophylactic point of view. Compliance with the intended prophylactic starting time is, however, more or less unknown. In one study by our group, 2 hours preoperatively in the protocol turned out to be 2.3 (0.2 - 9.3) hours in reality. Three prophylactic situations will be scrutinized: prophylaxis in hip fracture surgery, prophylaxis with oral anticoagulants and prophylaxis with low molecular weight heparins. Hip fracture patients have two main risk situations for development of DVT, the trauma causing the fracture and the surgical procedure. Most recent studies institute prophylaxis immediately at admission and there is at least one controlled study supporting such a practice. Concerning oral anticoagulation, where it takes a few days to obtain an adequate drug effect, variations are great. The first dose must be given at least irmnediately postoperatively but only a couple of studies have systematically studied thus problem. In recent years two modifications have occurred (minidose warfarin and two step warfarin) with the aim of maintaining the prophylactic effect with a reduced risk for haemorrhagic complications. In hip surgery, minidose warfarin is not effective. Concerning low molecular weight heparin, most studies start prophylaxis 2 hours preoperatively, but there are a few where the first dose is given in the evening before surgery with a good prophylactic effect and also postoperative start seems to be effective.
ABSTRACTS OF 12TH INTNAT’L CONGRESS
s21
S38 PREVENTION OF DEEP VEIN THROMBOSIS IN ORTHOPEDIC SURGERY A. Planes, N. Vochelle, M. Fagola Clinique Radio-Chirurgicale du Mail, La Rochelle, F In our presentation we will address some of the main questions raised in the prevention of deep vein thrombosis (DVT) in orthopedic surgery. We will describe them, and when possible, try to give an answer. These questions are: 1* What is the natural history of DVT and pulmonary embolism in various orthopedic situations? 2p What the methods of prophylaxis are used and what is their efficacy? 3* What is the best strategy to prevent fatal PE? 4* What modification of the natural history of DVT is induced by an effective prophylaxis? 5* What is the cost-effectiveness of prophylaxis? 6* What axe the new difficult, unanswered questions?
s39
when to start venousthromboembolismprevention in sutgery. D Bergqvist - Sweden To start prophylaxis in order to have it functioning during the operation has undoubtedly been effective from a prophylactic point of view. Compliance with the intended prophylactic starting time is, however, more or less unknown. In one study by our group, 2 hours preoperatively in the protocol turned out to be 2.3 (0.2 - 9.3) hours in reality. Three prophylactic situations will be scrutinized: prophylaxis in hip fracture surgery, prophylaxis with oral anticoagulants and prophylaxis with low molecular weight heparins. Hip fracture patients have two main risk situations for development of DVT, the trauma causing the fracture and the surgical procedure. Most recent studies institute prophylaxis immediately at admission and there is at least one controlled study supporting such a practice. Concerning oral anticoagulation, where it takes a few days to obtain an adequate drug effect, variations are great. The first dose must be given at least irmnediately postoperatively but only a couple of studies have systematically studied thus problem. In recent years two modifications have occurred (minidose warfarin and two step warfarin) with the aim of maintaining the prophylactic effect with a reduced risk for haemorrhagic complications. In hip surgery, minidose warfarin is not effective. Concerning low molecular weight heparin, most studies start prophylaxis 2 hours preoperatively, but there are a few where the first dose is given in the evening before surgery with a good prophylactic effect and also postoperative start seems to be effective.