Prevention of thromboembolism in orthopedic surgery: Application of rivaroxaban in arthroplastic procedures

Arthroplastic surgeries, the installation of total hip and knee prostheses are expanding, as a consequence of the increasing elderly population and the consequent increase in degenerative joint diseases. Prolonged life expectancy has also increased the number of patients with hip fractures requiring surgical treatment. In both groups of patients there is a marked risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE), which as serious complications, both during and after hospitalization, can be fatal. Therefore, prevention of DVT is necessary in all these patients. This article presents widely used methods of mechanical prophylaxis in orthopedic practice, along with essential methods of pharmacological prophylaxis, which include aspirin, vitamin K antagonists, unfractionated heparin (UFH), and also more modern low molecular weight heparins (LMWH), as well as new preparations - direct oral anticoagulants (DOAC), with special reference to rivaroxaban. It is recommended that in patients with hip fractures and patients after arthroplastic procedures, DVT prophylaxis is applied for 42 days before and after the operation.