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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2006 June;57(3):71-86
Deep venous thrombosis prophylaxis in orthopaedics and traumatologo. Medicolegal aspects
Baronetti M., Bruzzone M., Dettoni F., Rossi R., Castoldi F., Collo G. L., Rossi P.
3rd Department of Orthopaedics and Traumatology University of Turin Medical School Mauriziano “Umberto I “ Hospital, Turin, Italy
The use of anti-thromboembolic prophylaxis in orthopaedic surgery is by now a universally accepted praxis. In literature many doubts remain regarding type of prophylaxis, duration, and timing of administration. The use of anti-thromboembolic prophylaxis can be carried out almost anywhere, without serious problems, with a moderate costs, with a good cost-benefit outcome. In Italy legal suits for medical professional responsibility are beyond 10 000 and orthopaedists are among the most exposed. It has been estimated that in ortho-paedic surgery the incidence of fatal PTE in patients without prophylaxis is greater than 1%. Without a shadow of a doubt, the demonstration of efficacy of anti-thromboembolic prophylaxis have assumed that in cases where prophylaxis was not carried out or was carried out incorrectly the doctor is liable of malpractice. Like in all medical activities, also for anti-thromboembolic prophylaxis guidelines and protocols always have greater clinical and particularly forensic meaning. In administrating the treatment of anti-thromboembolic prophylaxis the concept of information without consent must be applied. Thromboembolic disease is a expected complication; when it is not foreseen for omission, improper action, inexperience, unawareness or negligence, the manifestation of a thromboembolic event can be defined as an unexcusable mistake, therefore depicting professional guilt. In the event that all preventive evaluation has been done (risk factors), and a correct and adequate prophylaxis has been carried out (according to the most recent scientific acquisitions), taking care of every possible side/undesired effect, the manifestation of a thromboembolic event will be difficultly attributed to professional responsibility.