Research

Thromboembolic management in orthopaedic patients

The thromboembolic disease problem continues to cause consternation on both sides of the Atlantic. Surgeons preferring variably aspirin, low molecular weight heparin, extended regimes, or other strategies (such as early mobilisation and calf pumps), seem to struggle to balance the risks and benefits of complications of anticoagulation with the rare (but potentially fatal complication) of pulmonary embolism. Bearing in mind the increasing number of arthroplasties, fractures, and other musculoskeletal surgeries performed each year worldwide, balancing the risks with this potentially fatal complication remains a complex challenge. A review team from Sofia (Bulgaria) has undertaken a fairly comprehensive review of the need for, the complication rate of and current standards of compliance for thromboprophylaxis. This review makes essential reading for the practicing orthopaedic surgeon and researchers alike. The study team outline the current state of practice with evidence to suggest that thromboprophylaxis may be inadequate in up to 50% of patients. They trace the evidence for and the efficacy of both low molecular weight heparins (LMWHs) and the direct oral inhibitors of clotting factor Xa.³ Despite newer regimes and awareness of the problem, thromboembolism continues to occur in up to 10% of our patient population. It is curious that despite millions spent on large randomised controlled trials, widely published health campaigns, and a wealth of scientific literature, experts cannot agree as to the best method for reducing thromboembolic risk, what that risk is, and how best to mitigate it.