Thromboprophylaxis in orthopedic surgery: how long is long enough?

Am J Orthop (Belle Mead NJ). 2009 Aug;38(8):394-401.


Pharmacologic thromboprophylaxis with low-molecular-weight heparins, vitamin K antagonists, or fondaparinux is well tolerated and effective in preventing venous thromboembolism (VTE) in major orthopedic surgery but is often limited to in-hospital use. However, 45% to 80% of all symptomatic VTE events occur after hospital discharge. Extended-duration VTE prophylaxis for 28 to 35 days reduces risk for late VTE by up to 70%. In this article, I review the evidence supporting guideline recommendations regarding extended-duration prophylaxis after major orthopedic surgery and provide an overview of current and emerging literature regarding prevention of postoperative VTE in patients undergoing this surgery.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticoagulants / therapeutic use*
  • Hospitalization
  • Humans
  • Meta-Analysis as Topic
  • Orthopedic Procedures / adverse effects*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Practice Guidelines as Topic
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / prevention & control*
  • Randomized Controlled Trials as Topic
  • Time Factors
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*


  • Anticoagulants