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Marcelli F. 1, Carnemolla A. 1, Gatti M. 1, Santini M. 1, Viliani T. 2, Pieri A. 1
1 Section of Angiology, 2nd Cardiology Unit A.O.U. Careggi, Florence, Italy
2 Agency for Recovery and Rehabilitation A.O.U. Careggi, Florence, Italy
Aim. Patients who underwent major orthopaedic surgery have a very high risk of deep venous thrombosis (DVT). Nevertheless guidelines of major scientific societies recommend with grade 1A not to perform pre-discharge screening with color duplex (CD).
Methods. We evaluate 241 consecutive patients who underwent surgery for Hip Fracture Surgery (HFS), elective Total Hip Replacement (THR) or Total Knee Replacement (TKR) before admission in an Intensive Rehabilitation Care Unit. Patients wit any DVT were treated with full dose anticoagulation. In case of proximal DVT the rehabilitative program was postponed of at least 7 days. Three months after screening patients were contacted by phone or, if they suffered DVT, they were investigated again with CD.
Results. total DVT amounted for 23.3%, with some differences in various surgical sub-groups. No proximal extension of distal DVTs, no pulmonary embolism nor major bleedings were observed.
Conclusion. In our casistic the incidence and the distribution of DVT do not vary from previous reported data in literature. Nevertheless zero incidence of clinically evident pulmonary embolism is a noteworthy result. Even if in some settings the recommendations about CD screening in major orthopaedic surgery can be valid, we think that our aggressive diagnostic protocol can lead to good results for the prevention of pulmonary embolism and of post-thrombotic syndrome in those settings where color duplex is performed by experienced operators.