II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology

Abstract

Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

Effects of Natural Hirudin and Low Molecular Weight Heparin in Preventing Deep Venous Thrombosis in Aged Patients with Intertrochanteric Fracture

“…LMWH is the preferred anticoagulant recommended in many guidelines 18 – 20 , and its use is well-known and accepted by the vast majority of doctors. Other anticoagulant options include warfarin, rivaroxaban, and dabigatran 21 , 22 .…”

The Effect of Aspirin and Enoxaparin on the Prevention of Venous Thromboembolism in Patients With Ankle Sprain and Cast Immobilization: A Randomized Clinical Trial

“…American College of Chest Physicians Guidelines does not suggest pharmacological thromboprophylaxis in these patients [10]. In contrast, national guidelines or expert recommendations published in several Western European countries recommend thromboprophylaxis, at least in certain patients with other VTE risk factors [11][12][13][14][15][16][17][18][19].…”

Pharmacological prevention of venous thromboembolism in orthopaedic surgery

“…In all these cases, pharmacological prophylaxis should be administered for a minimum of 7 days. The duration of the prophylaxis should also take into account the persistence of thromboembolic risk factors and the recovery of mobility and weight bearing (at least 10-20 kg) (5). An important novelty on the horizon is represented by NOAs which have been recently trialed.…”

“…The risk of VTE is conditioned by the interaction of two types of factors: (a) individual risk factors, linked to the conditions and characteristics of the patients themselves (e.g individual or family history of VTE, known congenital or acquired thrombophilia, active cancer or cancer treatment, prolonged immobilization, age, pregnancy, puerperium, oestrogen contraceptive or hormone replacement therapy); (b) treatment-related factors, arising from the specific features and consequences of the surgical or nonMini-review © C I C E d i z i o n i I n t e r n a z i o n a l i surgical procedure employed (e.g. the position of the patient on the operating table, particularly if prone, any forced twisting or traction of a limb that could damage the blood vessels, the use of additional medical devices, the length of time before the patient returns to normal ambulation) (5). Unlike the more precise and individual stratification of thrombotic risk, the definition of bleeding risk is often limited to mere suggestions, 'empirical' recommendations, frequently not supported by clinical trials.…”