Pharmacological thromboprophylaxis and total hip replacement

Fatal pulmonary embolism (PE) after total hip replacement (THR) is considered to be an important and avoidable cause of death (Campling Ct al 1993). The National Institutes of Health, the Thromboembolic Risk Factors and the European Consensus conferences all classified THR as a high-risk procedure and recommended that some form of heparin should be used as prophylaxis (NIHCC 1986; ECC 1992; THRIFT 1992). We believe that the rate of fatal PE is an order of magnitude lower than is generally assumed and that there is not adequate evidence to support guidelines recommending pharmacological rather than mechanical methods of prophylaxis. High-risk procedures have been defined as those in which the rate of calf deep-vein thrombosis (DVT) is 40%