Prevention of venous thromboembolism

Luisella Pedrotti, Redento Mora, Giovanni Battista Galli, Gabriella Tuvo

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Venous thromboembolism (VTE), which can present clinically either as deep venous thrombosis (DVT) or as pulmonary embolism (PE), is observed quite frequently, often complicating surgery. In orthopaedic and trauma surgery it has been estimated that, without anti-thrombotic prophylaxis, the rate of DVT was 45%?57% (23%?26% proximal) in total hip replacements, 40%?84% (9%?20% proximal) in total knee replacements, and 45%?50% in proximal femoral fractures [1-3]. An accurate evaluation of the incidence of VTE in patients with lower limb fractures or soft tissue injuries is difficult at the present time, due to the lack of research on this topic. A reliable estimate of VTE incidence in lower limb fractures is 6%?45 % (4%?8% proximal). Exact data on the frequency of VTE in upper limb fractures are not available; nevertheless, the risk of PE in conjunction with DVT of the upper limb is considerable. With regard to the injuries of the soft tissues, such as tendons, it has been calculated that the DVT rate in these injuries is about 50% of the rate in bone injuries [3]. DVT must be rapidly diagnosed, not only in order to establish a suitable therapeutic strategy in the acute stage but also to prevent relapses and further complications. Without adequate and rapid medical treatment, the risk of relapse seems to be 40% in the first month after the primary event and 10% during the second and the third month [4]. Since a possibly fatal PE can follow DVT, it is mandatory that the clinical clues of such a disease not be underestimated. Edema, more or less associated with skin color alterations and pain (described sometimes as cramp and sometimes as heaviness and which increases upon local pressure) actually are not signs or symptoms specific for DVT; in fact, they can obscure a vascular disease of different origin, for example, superficial thrombophlebitis, lymphedema, or vasculitis. They can also be the expression of orthopaedic diseases such as stretching,muscular, or tendon ruptures or rupture of a synovial cyst [5]. However, these symptoms become increasingly significant in the presence of risk factors predisposing to thrombotic events by themselves.

Original languageEnglish
Title of host publicationNonunion of the Long Bones: Diagnosis and Treatment with Compression-Distraction Techniques
PublisherSpringer Milan
Pages247-255
Number of pages9
ISBN (Print)884700408X, 9788847004085
DOIs
Publication statusPublished - 2006

ASJC Scopus subject areas

  • Medicine(all)

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