Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital, Jl. Jend. Gatot Subroto Kav. 59, Jakarta, 12950, Indonesia,
Curr Rev Musculoskelet Med. 2014 Jun;7(2):108-16. doi: 10.1007/s12178-014-9207-1.
Venous thromboembolism (VTE) has been identified as an immediate threat to patients undergoing major orthopedic procedures such as total hip arthroplasty (THA) and total knee arthroplasty (TKA). Given the known dangers of VTE, arthroplasty surgeons are sensitive to the need for VTE thromboprophylaxis. However, the modalities of thromboprophylaxis used to minimize the risks to patients have been variable. Clinical practice guidelines have been published by several professional organizations, while some hospitals have established their own protocols. The 2 most popular guidelines are those published by the Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP), both from North America. Prior to 2012, these recommendations varied depending on underlying definitions, methodology, and goals of the 2 groups. For the first time, both groups have similar recommendations that focus on minimizing symptomatic VTE and bleeding complications. The key to determining the appropriate chemoprophylaxis for patients is to balance efficacy of a prophylactic agent, while being safe in regards to bleeding complications. However, a multimodal approach that focuses on early postoperative mobilization and the use of mechanical prophylaxis, in addition to chemoprophylaxis, is essential.
静脉血栓栓塞症（VTE）已被确定为接受重大骨科手术（如全髋关节置换术 [THA] 和全膝关节置换术 [TKA]）的患者的直接威胁。鉴于 VTE 的已知危险，关节置换外科医生对 VTE 血栓预防的需求非常敏感。然而，用于最大限度降低患者风险的血栓预防方法各不相同。一些专业组织已经发布了临床实践指南，而一些医院则制定了自己的方案。北美最受欢迎的 2 个指南是由矫形外科医师学会（AAOS）和胸科医师学会（ACCP）发布的。在 2012 年之前，这些建议因 2 组的基本定义、方法和目标而异。这两个组首次提出了相似的建议，重点是最大限度地减少症状性 VTE 和出血并发症。确定患者适当的化学预防措施的关键是平衡预防剂的疗效，同时避免出血并发症。然而，除了化学预防外，还必须采用关注术后早期活动和使用机械预防的多模式方法。
