Antithrombotic Therapy. SIGN Guideline. SIGN Publication No. 36 ISBN 1899893 76 8 Published March 1999

Authors: Peter B. Rauh, FRCS, Matthew C. Solan, FRCS, and Riyaz H. Jinnah, M.D. Orthopaedic patients undergoing lower limb surgery are recognized as a group at especially high risk of DVT/PE. Prevention is therefore of great importance. Treatment of established DVT or PE is beyond the scope of this text. This chapter will consider prophylactic measures only.

Clinical Signs for DVT:
- exam may be unreliable but positive findings should not be ignored;
- calf tenderness, swelling, fever, & increased pulse rate may be present
- suggestive exam features for pulmonary embolism:
- sudden decrease in O2 saturation;
- tachypnea, cyanosis, and hypoxia;
- pulmonary consolidation, pleural effusion, wheeze, and cor pulmonale;
- new onset tachydysrhythmia (usually a. fib);

Prophylaxis using heparin and low molecular weight heparin
Heparins and some mechanical pumping devices may help prevent blood clots forming in the legs after surgery for hip fracture
Patients with hip fracture may develop blood clots (thrombosis) in their legs. Some of these blood clots may travel to the lungs and cause a blockage (embolism), which can be fatal. Various drugs and physical devices are sometimes used to try and prevent these complications. This review of randomised trials found that both heparins and mechanical pumping devices significantly decrease the incidence of deep vein thrombosis. There was not enough evidence to conclude about the effect on lung (pulmonary) embolism, mortality or possible side effects for either heparin or mechanical methods.
Handoll HHG, Farrar MJ, McBirnie J, Tytherleigh-Strong G, Milne AA, Gillespie WJ