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What is the state of the art in orthopaedic thromboprophylaxis in lower extremity reconstruction?

Venous thromboembolic events, including deep venous thromboses and pulmonary embolisms, have a high risk of occurrence in patients treated with lower extremity arthroplasty and hip fracture surgery. Although the prevalence of these complications has been lowered with the use of venous thromboembolic prophylaxis, the current rate is still troublesome because of the possibility of death or the need for lifetime treatment of postthrombotic syndrome and/or pulmonary hypertension. Prophylactic methods currently include mechanical devices and pharmacologic agents. Mechanical devices are difficult to compare because they are not standardized, the devices are often used in multimodal prophylactic regimens, and the devices cannot be used when the patient is ambulating or at home. A new portable compression device allows use during ambulation and can be used by the patient at home. A recent study of this portable device in patients treated with total hip arthroplasty showed an efficacy similar to that of low-molecular-weight heparin, with fewer major bleeding complications. Pharmacologic prophylaxis includes low-molecular-weight heparin, synthetic pentasaccharide, warfarin, and aspirin. All of these agents have different degrees of efficacy and safety. New oral agents for thromboprophylaxis are on the horizon but are not yet approved by the Food and Drug Administration.