Thromboembolic disease in orthopedic patients: prophylaxis and treatment

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Abstract

Thromboembolic disease ranks among the most common and dangerous complications of skeletal trauma and elective major joint replacement. The incidence of pulmonary embolism is increasing, and fatalities from this complication have risen substantially. Pulmonary emboli are now the leading cause of hospital admissions for respiratory diseases other than pneumonia. Venography is currently the most accurate method of detecting thrombosis. It is a safe procedure with no major complications. The 125I labeled fibrinogen test is likely to yield more false negative and false positive results than venography and is not applicable near a large wound. Clinical signs and symptoms are unreliable: venous thrombosis is revealed by clinical examination in less than half the patients who develop it. The pathogenesis of thrombosis remains elusive. Available evidence strongly suggests, however, that the thrombotic process begins during operation. Consequently, greater attention should be given to the use of prophylactic agents before, and certainly during, the operative procedure. Numerous clinical trials have proved that 2 agents given prophylactically, the anticoagulant crystalline sodium warfarin (Coumadin) and the antiplatelet agent dextran 40 (Rheomacrodex), reduce the risk of thromboembolic disease. The search continues for a safe oral agent uniformly effective in preventing thromboembolism.

Original languageEnglish (US)
Pages (from-to)57-60
Number of pages4
JournalContemporary Surgery
Volume6
Issue number4
StatePublished - 1975

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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