Abstract

The efficacy of in-hospital prophylaxis against venous thromboembolic disease after elective total hip arthroplasty is well documented in the literature. Lowmolecular- weight heparins, early ambulation, and the arterio-venous impulse system foot pump have been accepted as an efficacious form of prophylaxis against deep venous thrombosis after total hip arthroplasty. Consequently, orthopedic surgeons generally use pharmacologic or mechanical methods, or both, as prophylaxis against this complication. In contrast, there has been recent debate in the literature concerning the options for prophylaxis against venous thromboembolic disease after hospital discharge. Various approaches have been suggested and are being used in daily clinical practice. One option is to screen all patients routinely with ascending venography before discharge from the hospital; another option is to screen all patients routinely with duplex ultrasonography before discharge from the hospital; finally, extending pharmacologic prophylaxis with a low-molecular-weight heparin for at least 3 weeks after hospital discharge might be justified. Recently, this issue was further addressed in a Belgian multicenter trial confirming a potential benefit for continued low-molecular-weight heparin prophylaxis after hospital discharge, especially when patients have a limited mobility.