Multimodal prophylaxis of venous thrombosis.

Overview

Although deep vein thrombosis has consistently been a serious postsurgical complication of total hip arthroplasty, the risk of thromboembolic disease has declined substantially in the past 3 decades. From the late 1980s through the early 1990s, the reported rate of nonfatal pulmonary embolism following total hip arthroplasty ranged from 1.0% to 1.2%, and the rate of fatal pulmonary embolism was 0.4% or lower. Even lower rates have been observed more recently. The decreasing risk of postsurgical complications reflects considerable advances in our understanding of the pathophysiology of deep vein thrombosis related to total hip arthroplasty and improvements in regional anesthesia, surgical technique, and perioperative prophylaxis. Among the factors that reduce the risk of thromboembolism discussed in this article are: preoperative autologous blood donation; hypotensive epidural anesthesia with epinephrine infusion; administration of unfractionated heparin during surgery, before femoral preparation, when the thrombogenesis is maximally stimulated; expeditious surgery, minimizing femoral vein occlusion and blood loss; pneumatic compression and patient mobilization with foot exercises immediately after surgery; and early ambulation.