Eichinger Sabine, Kyrle P A
Dept. of Internal Medicine I, Div. of Hematology and Hemostasis, Medical University of Vienna, Austria.
Eur J Med Res. 2004 Mar 30;9(3):112-8.
In the absence of thromboprophylaxis, venous thromboembolism (VTE) affects about 50 to 80% of the patients after total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery. Since stratification of patients in those who will become symptomatic and those who will not, is not possible, primary high risk thromboprophylaxis should be provided to all patients undergoing major orthopedic surgery of the lower extremity. Various non-pharmacologic and pharmacologic thromboprophylactic measures have been evaluated. With regard to pharmacologic thromboprophylaxis unfractionated heparin has now almost completely been replaced by low molecular weight heparin (LMWH) for VTE prophylaxis. The use of acetylsalicylic acid for thromboprophylaxis in patients undergoing major orthopedic surgery of the lower extremities is not recommended. The optimal beginning of LMWH thromboprophylaxis is either 2 hours preoperatively or 6 to 8 hours postoperatively. Extended thromboprophylaxis (beyond 7 to 10 days after surgery) is recommended for high-risk patients. New antithrombotics, such as fondaparinux or (xi)melagatran, significantly reduce the risk of asymptomatic but not of symptomatic VTE compared to LMWH. In the light of other potential side effects (e.g., an increased bleeding risk) and high costs the role of these new drugs in the prophylaxis of VTE in patients undergoing major orthopedic surgery of the lower extremities remains to be established.
在未进行血栓预防的情况下，全髋关节置换术（THR）、全膝关节置换术（TKR）或髋部骨折手术后，约50%至80%的患者会发生静脉血栓栓塞（VTE）。由于无法将患者分为有症状和无症状两类，因此应对所有接受下肢大型骨科手术的患者进行一级高风险血栓预防。已对各种非药物和药物性血栓预防措施进行了评估。在药物性血栓预防方面，普通肝素现已几乎完全被低分子量肝素（LMWH）取代用于VTE预防。不推荐在接受下肢大型骨科手术的患者中使用乙酰水杨酸进行血栓预防。LMWH血栓预防的最佳开始时间为术前2小时或术后6至8小时。对于高危患者，建议延长血栓预防时间（术后7至10天以上）。与LMWH相比，新型抗栓药物，如磺达肝癸钠或希美加群，可显著降低无症状VTE的风险，但不能降低有症状VTE的风险。鉴于其他潜在副作用（如出血风险增加）和高成本，这些新药在下肢大型骨科手术患者VTE预防中的作用仍有待确定。
