Venous thromboembolic disease after hip surgery: risk factors, prophylaxis, and diagnosis

Thromboembolism is a recognized complication of elective and emergency hip surgery. Because of the high incidence of venous thrombosis, prophylactic measures are necessary. Numerous modalities have been explored, and this review formulates strategies to prevent this potentially lethal complication. While minidose heparin and anti-platelet agents may provide effective thromboembolism protection for some patients, their effect in patients treated with hip surgery is limited. Dextran 40 is useful in younger patients treated with hip arthroplasty who are at risk for bleeding complications and who can tolerate volume overload. Heparin dihydroergotamine is an alternative to oral anticoagulants and may cause fewer bleeding complications than oral anticoagulants. Low molecular weight heparin and adjusted-dose heparin can also be used effectively in hip surgery. Warfarin is perhaps the most effective regimen when the prothrombin time is maintained at 1.2-1.5 times control. The risk of thrombosis for patients treated with either emergency or elective hip surgery is significant, and numerous additional factors can increase the likelihood of this complication. The best approach to this problem is prevention, which is effective, safe, and economical.