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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2000 September;24(3):209-14
Active prophylaxis of postoperative thromboembolic complications in foot surgery
One of the most controversial topics in modern foot surgery is the use and type of prophylaxis used to contain postoperative thromboembolism that is estimated by various authors to occur in 50 to 80% of non-treated cases undergoing orthopedic surgery. Foot surgery is not comparable to major orthopedic surgery owing to the different level of invasiveness, trauma and the range of population affected. The potential thromboembolic risk must be assessed only on the basis of the patient's conditions and the presence of the risk factors identified by the European Consensus Statement. When the risk is high or moderately high, anticoagulant treatment is required generally in the form of low molecular weight heparin, starting 24 hours prior to surgery and continued until the patient is fully mobilised. It is also useful to associate this with active surgical prophylaxis, extending also to those patients not receiving heparin therapy. This consists of pre-, intra- and postoperative treatment to prevent the onset of pathogenetic conditions leading to thrombogenesis. Three thousand and seven patients operated between 6 April 1989 and 20 July 2000 at the ''Prof. G. Pisani'' Foot surgery centre in Turin underwent active operating prophylaxis. Heparin therapy; was associated in 7% of cases owing to the presence of one or more risk factors. All patients were monitored until full orthopedic recovery took place with a 0.2% incidence of deep venous thrombosis and no cases of thromboembolism.