Tromboprofilaksia

Tromboprofilaksia, or thromboprophylaxis, is a medical approach to prevent venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It is used in patients at elevated risk due to surgery, hospitalization, cancer, or immobilization. The aim is to lower the incidence of VTE while balancing the risk of bleeding.

Strategies are divided into pharmacological and mechanical methods. Pharmacological prophylaxis uses anticoagulants given at prophylactic doses, such as low-molecular-weight heparin (LMWH, e.g., enoxaparin, dalteparin) or unfractionated heparin, and in some settings direct oral anticoagulants (DOACs, e.g., rivaroxaban, apixaban). Mechanical prophylaxis includes graduated compression stockings and intermittent pneumatic compression devices, which may be used alone when anticoagulation is contraindicated or as an adjunct.

Indications and risk assessment: major orthopedic surgery (hip or knee replacement), other abdominal or pelvic surgeries, cancer-related surgery, prolonged immobilization, and certain medical illnesses (pneumonia, heart failure) require assessment of VTE risk. Tools such as the Caprini or Padua scores help tailor therapy. Contraindications to pharmacological prophylaxis include active major bleeding, severe thrombocytopenia, and certain recent hemorrhagic events; renal function and liver function influence choice and dosing.

Duration and outcomes: postoperative pharmacological prophylaxis is typically continued for 7–14 days and up to 4 weeks after major orthopedic procedures. Mechanical methods can be used long-term if pharmacologic therapy is not possible. Prophylaxis reduces DVT and PE but carries a risk of bleeding and rarely heparin-induced thrombocytopenia.

Guidelines from professional bodies recommend risk-based prophylaxis with attention to patient factors and local drug availability.