Patients with lower limb fractures frequently require orthopedic surgery during first week after trauma. What is your preferred approach if concomitant deep vein thrombosis is diagnosed? Do you will postpone surgery as long as possible or will procede to intervention on fully anticoagulated patient?
Thank you Dr. Ashwood for your point of view.
I am agree that early mobilization, that can be achieved by orthopedic surgery, is extremely important. From other point of view, any surgery performed in acute phase of DVT can, at least theoretically, agravate the thrombosis. Furthermore, in case of proximal (popliteal or above) DVT prescription of the prophylactic doses of LMWH is not appropriate according to existing VTE guidelines. Do you know some studies published in this field?
Excellent! We have one more point of view.
My question is based on practical experience. I was invited by orthopedic surgeons for consult in 2 consecutive patients with proximal hip fracture and DVT from popliteal to common femoral vein. In view of orthopedic surgeons the intervention was indicated.
After multidisciplinary discussion we consideed that there are not indications for cava filter. Surgery was postponed for 3 weeks and patients were treated with rivaroxaban 30 mg. After 3 weeks patients were switched to intermediate doses of LMWH and operated. There where not hemorrhagic or thrombotic events during and after surgery.
I was curious to find some evidence based reccomendation in this field, but without success.
Can you share some articles/protocols/guidelines?
- Badges
- Science topic
- Similar topics
- Phytochemistry
- Extracts