University of Rochester Medical Center, Rochester, NY 14642, USA.
J Thromb Thrombolysis. 2013 Apr;35(3):359-67. doi: 10.1007/s11239-013-0889-9.
Venous thromboembolism (VTE) is a serious risk after major orthopedic surgery (MOS) including total knee replacement, total hip replacement and hip fracture surgery. This risk can be reduced with several pharmacologic and mechanical prophylactic approaches, and the choice among them depends on their ability to reduce VTE with an acceptable increase in adverse events, especially major bleeding complications. Improvements in medical and surgical care have led to a progressive decrease in the risk of VTE after MOS with an estimated baseline risk with contemporary practice of approximately 4.3 % up to day 39 after surgery. Low-molecular-weight heparin is the most thoroughly studied thromboprophylactic agent following MOS and demonstrates good effectiveness with an acceptable rate of bleeding complications. Warfarin, rivaroxaban, dabigatran, and apixaban have all been studied in large trials in comparison with low-molecular-weight heparin and also show an acceptable benefit: risk ratio. Mechanical approaches including graduated compression stockings, intermittent pneumatic compression and venous foot pump also offer protection against VTE, but there is less evidence is available regarding their effectiveness and risks. Combination therapy consisting of an antithrombotic agent and mechanical device is probably more effective than either alone. The appropriate use of thromboprophylaxis after MOS results in reduced VTE with acceptable bleeding risks.
静脉血栓栓塞症（VTE）是骨科大手术后（MOS）的严重风险，包括全膝关节置换术、全髋关节置换术和髋部骨折手术。可以通过多种药理学和机械预防措施来降低这种风险，选择哪种方法取决于它们降低 VTE 的能力，同时还要考虑不良事件的增加程度，尤其是大出血并发症。随着医疗和手术护理的改善，MOS 后 VTE 的风险逐渐降低，目前大约有 4.3%的基线风险，持续到术后 39 天。低分子肝素是 MOS 后最深入研究的血栓预防药物，其有效性良好，出血并发症发生率可接受。华法林、利伐沙班、达比加群和阿哌沙班均已在大型试验中与低分子肝素进行了比较，并且也显示出可接受的获益：风险比。包括梯度压力袜、间歇性气动压缩和静脉足泵在内的机械方法也可以预防 VTE，但关于它们的有效性和风险的证据较少。抗血栓药物和机械装置联合治疗可能比单独使用更有效。MOS 后适当使用血栓预防措施可降低 VTE 的发生风险，同时可接受出血风险。
