Extended Venous Thromboembolism Prophylaxis After Total Hip ReplacementA Comparison of Low-Molecular-Weight Heparin With Oral Anticoagulant

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Abstract
POSTOPERATIVE DEEP vein thrombosis and pulmonary embolism are feared complications after orthopedic surgery. Patients who undergo total hip replacement are at high risk for complicating venous thromboembolic disease.1,2 Low-molecular-weight heparin regimens have simplified pharmacologic prophylaxis because of the use of a fixed-dose once-daily subcutaneous injection that does not require anticoagulant monitoring. Low-molecular-weight prophylaxis is effective, safe, and cost-effective in patients undergoing elective hip surgery.3-8 Clinical issues that are currently debated include the uncertainty as to the relative effectiveness and safety of extended low-molecular-weight heparin prophylaxis vs extended oral anticoagulant regimens after elective hip surgery. Multiple studies have compared extended out-of-hospital low-molecular-weight heparin prophylaxis against placebo in patients undergoing elective hip surgery with the use of a venographic end point.8-12 A significant and clinically important difference was consistently noted among the studies in favor of low-molecular-weight heparin prophylaxis. Extended low-molecular-weight heparin prophylaxis was effective and safe.