Title : Up-to-date of thromboprophylaxis in orthopedic/spine surgery
Orthopedic patients are among those at highest risk of developing post-operative venous thromboembolic complications. In an orthopaedic patient all processes described in the Virchow’s triad in 1884 are presented. Symptomatic venous thromboembolism (VTE) within three months without TE prophylaxis are in the range of 1.3 to 10 %. Therefore, anticoagulant is essential for those patients. There are still discussions about the right choice of anti-coagulant are going on. Factor Xa inhibitor is the compound that has increased the most as anti-coagulant (annual growth rate of 43%) in orthopedic patients followed by aspirin (30%). Nevertheless, the National Institute of Health and Care Excellence (NICE) study and the European guidelines on perioperative prophylaxis against venous thromboembolism of 2018 recommend low molecular weight heparin (LMWH) and Aspirin. This leaves direct oral anticoagulants (DOACs) as alternative for preventing deep vain thrombosis (DVT) in orthopedic patients. We are still seeking consensus in perioperative anticoagulation in orthopedic patients and particularly in those undergoing major spinal surgery. For the latter patients, at hight risk of contracting VTE, the American college of chest physicians (ACCP) in 2012 recommended prophylaxis with LMWH. However, still some questions remain; when is the optimal time to start prophylactic treatment and for how long time should it continue? Would it be more preferable to administer oral anticoagulants? Although, there is still a lack of evidence concerning DOACs in major spinal surgery, numerous reports and ongoing trials are available presenting their data of DOACs in comparison with LMWH in spinal patients at hight risk of contracting VTE.