Comparative Effectiveness

Extending use of anti-clotting medication following major orthopedic surgery may help prevent post-operative blood clots

For patients who have undergone major orthopedic surgery such as hip or knee replacement, extending post-surgery use of medications to prevent blood clots may be beneficial, according to a new review by the Agency for Healthcare Research and Quality (AHRQ). Blood clots in the legs, pelvis, lungs, or other areas, as well as other bleeding issues, are common among major orthopedic surgery patients.  While current standard clinical practice recommends that patients take these medications for 7-10 days following surgery, the new research review finds that extending use to 28 days or longer may increase benefits.

Among the many types of available anti-clotting medications, there is not enough evidence to determine which type of medication is best. However, within the heparin class of medications, the review found that low molecular-weight heparin is superior to unfractionated heparin. The review calls for further studies to evaluate the use of medications after less serious types of orthopedic surgery. More research is also needed to compare the effectiveness of using one medication or combining multiple medications, as well as combining medications with other types of therapies, such as leg compression or foot pumps. The review also notes that there is not currently enough evidence to conclude that deep vein thrombosis, blood clots in the veins, causes pulmonary embolism, an often fatal blockage of the main artery of the lung. 

To access the review, Venous Thromboembolism Prophylaxis in Orthopedic Surgery, and other AHRQ products, visit AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov.

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