The ACCP Guidelines for Thromboprophylaxis in Total Hip and Knee Arthroplasty

被引:57
作者
Colwell, Clifford W., Jr. [1 ]
机构
[1] Scripps Clin, Shiley Ctr Orthopaed Res & Educ, La Jolla, CA USA
关键词
DEEP-VEIN THROMBOSIS; MOLECULAR-WEIGHT HEPARIN; VITAMIN-K ANTAGONISTS; VENOUS THROMBOEMBOLISM; PULMONARY-EMBOLISM; REPLACEMENT SURGERY; ORTHOPEDIC-SURGERY; NATURAL-HISTORY; POSTOPERATIVE FONDAPARINUX; TERM OUTCOMES;
D O I
10.3928/01477447-20091103-51
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The 1986 National Institutes of Health consensus conference Prevention of Venous Thrombosis and Pulmonary Embolism emphasized the high rates of venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), associated with orthopedic surgery of the lower extremity when performed without thromboprophylaxis, Total joint arthroplasty patients treated with placebo or as controls have, based on studies conducted between 1908 and 2002, a total DVT prevalence of 41% to 85% and a proximal DVT prevalence of 5% to 36% when examined by venography at 7 to 14 days. Prevalence of PE is less certain, but clinical studies have reported a range of 0.9% to 28% for all PE and 0.1% to 2% for fatal PE in control or placebo patients. As the number of total joint arthroplasties in the United States has grown-nearing 1,000,000 annually and expected to increase significantly over the next 20 years as the Population ages-so too has interest in appropriate thromboprophylaxis. Methods of preventing VTE are either pharmacologic or mechanical. Guidelines from the American College of Chest Physicians make evidence-based recommendations for both pharmacologic and nonpharmacologic prophylaxis in the settings of total hip and total knee arthroplasty. These recommendations and their underlying rationale are discussed herein.
引用
收藏
页码:67 / 73
页数:7
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