Venous Thromboembolism in the Hip Surgery Patient

Abstract

Venous thromboembolism is the most common and potentially lethal problem following elective or emergency hip surgery. Appropriate DVT prophylaxis is absolutely essential, as the incidence of both calf and proximal vein thrombosis is significant. Two to three percent of postoperative hip patients die secondary to pulmonary embolism.

Prophylactic measures include a variety of pharmacological and non pharmacological tools. Early mobilization, leg exercises, and gradient compression stockings constitute a minimum protocol. Low-dose Coumadin or low molecular weight heparin should be employed as a pharmacological prophylaxis.

If deep venous thrombosis is suspected, clinical judgment alone should not be a basis for treatment decisions. Venography or, if necessary, other modem diagnostic agents must be employed. If appropriate studies are positive, aggressive treatment with heparin followed by Coumadin is suggested.