Clinical trials have shown Low-molecular weight heparins (LMWHs) to be at least as safe and efficacious as unfractionated heparin (UFH) for preventing venous thromboembolism (VTE) in patients undergoing major orthopedic surgery who are at highest risk of developing VTE. The retrospective study was conducted at orthopedic department in Clinical Hospital – Stip for period of 12 months (January-December 2013), where LMWHs and UFH are accepted thromboprophylaxis options. 320 patients (144 males and 157 females, medium age 58 years and 70 years, respectively) were hospitalized for various types of major orthopedic surgical interventions. 212 (66%) patients were admitted because of hip or knee fractures, 26 (8%) had conditions after hip or knee fractures and 82 (26%) were hospitalized for removal or implanting of osteosynthetic devices. After the surgical intervention, patients were subjected to anticoagulant prophylaxis (UFH or LMWHs). Which type of prophylaxis will be used depended exclusively on the surgeon’s decision. VTE complications resulting death were observed in 8 (2.5%) out of 13 patients. Death because of PE occurred in 2 (25%) out of 8 patients, compared to 6 (75%) patients who had fatal DVT complications. The average hospital cost for patients treated with LMWHs prophylaxis as first line thromboprophylaxis option was 52831.92 MKD/patient compared to 70082.24 MKD/patient for UFH first line thromboprophylaxis option. We observed that LMWHs thromboprophylaxis, applied in recommended doses subcutaneously once a day, is potentially more effective and cost saving option compared to UFH and should be considered as pharmacological treatment of first choice for the prevention of VTE (DVT and PE) in patients recovering from major orthopedic surgery at the orthopedic department in Clinical Hospital Stip.
Keywords: Thromboprophylaxis, major orthopedic surgery, LMWHs, UFH
Advisory Board conclusion following the discussion "Controversial issues of low molecular weight heparins use in obstetrics"
