Treatment of venous thromboembolism in orthopaedic surgery

The mainstay of treatment for deep venous thrombosis and pulmonary embolism for the last 40 years has been adjusted-dosage intravenous heparin. Newer products that are administered as fixed dosing and other drugs that do not require frequent monitoring are discussed. This article is tailored to treatment practice and patterns followed in the orthopaedic subpopulation, especially in regard to timing of recent surgery and the possible effects of anticoagulation on an orthopaedic wound. The recommendations are based on categories that split the postoperative period into deep vein thrombosis occurring less than or greater than 48 hours postoperatively. The article identifies treatment modalities that should allow maximum treatment for the orthopaedic patient at risk for recurrence of clot while paying special attention to wound outcome.