Barriers to the optimal use of anticoagulants after orthopaedic surgery.

Venous thromboembolism (VTE) and the consequent morbidity and mortality associated with this condition continue to be a problem following orthopaedic surgery. The vast majority of patients undergoing orthopaedic surgery receive some form of thromboprophylaxis. However, the use of inappropriate thromboprophylaxis is an important factor which may explain why the clinical burden of VTE is still considerable. Barriers to the use of appropriate thromboprophylaxis include the belief by some surgeons that pharmacological thromboprophylaxis increases the risk of bleeding and the asymptomatic nature of deep vein thrombosis. In addition, in patients at risk of VTE, thromboprophylaxis should be given beyond the standard duration recommended in international or national guidelines, and many surgeons have concerns about adherence and adverse events in the outpatient setting. Furthermore, currently available anticoagulants have drawbacks, including the need for monitoring, or a subcutaneous route of administration. The introduction and implementation of multi-faceted and integrated approaches to thromboprophylaxis could improve adherence with current guidelines, extend appropriate thromboprophylaxis according to risk factors, and improve patient outcomes in this setting. In addition, the development of new anticoagulants with more convenient administration regimens and no need for monitoring may help to achieve these objectives.