بسم الله الرحمن الرحيم

T. J. A IS STRONG PROPENSITY FOR T. E COMPLICATION THAT IS POTENTIALLY LIFE - THREATENING

OBESITY CANCER PREVIOUS VTE FAMILY HISTORY SMOKING ADMISSION TO ICU DEHYDRATION THROMBOPHILIA CONTRACEPTIVE USE POST- OPERATION IMMOBILITY

CHARNLEY & CO: 7959 CASES OF T. J. A P- E : 8% FATAL CONDITION: 1% INSALL INCREASE ATTENTION TO T. E DISEAS AND EMPHASIS PREVENTION

DVT WITHOUT ANY PREVENTION 84%CLINICALLY P. E 1.7%FATAL P. E: - POSITIVE VENOGRAPHY NOT ITSELF ASSOCIATED WITH LOCAL SYMPTOMS

PRESENTATION OF T. E DISEASE FOLLOWING T. H. A & T. K. A IS DIFFERENT RELATED TO VIRCHOW’S TRIAD STASIS INTIMAL INJURY HYPERCOAGULABILITY

BEFORE ROUTINE USE OF CHEMOPROPHYLAXIS PROXIMAL DVT WAS IN % OF T. H. A DISTAL WAS IN T. K. A

PROXIMAL THROMBI ALMOST IS SEGMENTAL AND NEAR LESSER TROCH LARGE MORE EMBOLIZE GREAT HEMODYNAMIC IMBALANCE MORE P. E RESULT

RESULT OF INTIMAL DAMAGE TO FEMORAL VEIN WHICH IS TWISTED DURING POSITION OF L- L PREPARATION & DEVICE INSERTION

POTENT ANTICOAGULANTS MITIGATE INTIMAL INJURY & REDUCE PROXIMIL THROMBI IN T. H. A DISTAL THROMBI AFTER T. K. A IS MORE RELATED TO BLOOD STASIS 1- FOLDING 3- OCCLUSION TOURNIQUET & ANTIGOAGULANT AND IPC ALONE ARE NOT EFFECTIVE IN PREVENTION OF POPLITEAL VEIN

PREVENTION WITH IPC AND REGIONAL ANESTHESIA OR IPC + CHEMOPROPHYLAXIS

RELEAS OF THE TOURNIQUET AFTER T. K. A TRANSESOPHAGEAL ECHOCARDIOGRAPHY HAS NOISE IN ECHO PATTERN FROM: 1- EMBOLIC 2- BONE MARROW 3- ELMENTS FAT

FAT FROM AFTER INTRAMEDULLARY CANAL INTRAVASATION CANAL PREPARATION PRESSURIZATION ON STEM CEMENTATION

ORTHOPEADIC SURGEON EMPHASIS TO: 1- PROPHYLAXIS OF CLINICAL EVENTS 2- BALANCE THE RISK OF BLEEDING MORE THAN: PREVENTION OF VENOGRAPHIC DISEASE

AMERICAN COLLEGE OF CHEST- PHYSICIAN (ACCP) SUGESST THAT ANTICOAGULANT NEEDED AS SOON AS ELEVATED BLEEDING RISK SUBSIDE

REGIONAL ANESTHESIA REDUCE DVT VASODILATATION BETTER VENOUS RETURN RESEMBLE OF SYMPATHECTOMY NO EFFECT ON INTRAOPERATIVE THROMBOGENIE BUT VASODILATION STIMULATE OF INTIMAL FIBRINOLYSIS SPINAL EPIDURAL PROXIMAL CLOT 50% DISTAL CLOT 20%

2- PNEUMATIC COMPRESSION: - I. P. C ALONE IS NOT VERY EFFECTIVE - I. P. C & REGIONAL ANESTHESIA HAS SYNERGIC EFFECT TO PREVENT OF DVT

WESTRICH & COLLEAGUES SUGGEST IPC AND HEPARIN REDUCE DVT THAT SIGNIFICANTLY BETTER THAN WARFARIN OR ASPIRIN

3- ASPIRIN OVERALL ANTIPLATELER ARE INEFFECTIVE ON THE VENOUS SIDE OF CIRCULATION

RESULT OF STUDY IN PATIENT WITH T. J. A THAT ANALYSIS MORTALITY AT 1-6W 2- 3 MON G:A L. MW. H- XIMELAGTRAN - FONDAPARINUX G:B REGIONAL ANESTHESIA WITH OR WITHOUT 1- HEPARIN 2- IPC 3- ASPIRIN G: C WARFARIN

EMPHASIS THAT MULTIMODAL ASPIRIN PROPHYLALY IS BETTER ASPIRIN: REDUCE P. E. (CLINICAL MANIFESTATION OF V.T) SPECIALLY USE WITH REG- ANES

ACCORDINGLY: THERE IS BOTH EVIDENCE AND MOMENTUM GROWING TO JUSTIFY A RANDMIZED CLINICAL TRIAL COMPARING ASPIRIN – WARFARIN AND NEWER AGENT IN CONJUCTION WITH REG – ANES FOR VT PROPHYLAXIS AFTER T. J. A

SYMPTOMATIC & FATAL P. T. E IS MORE IN T. H. A THAN T. K. A RESIDUAL VENOGRAPHIC PREVALANCE OF DVT HAS BEEN MORE AFTER T. K. A

THIS MEAN THAT PREVENTION OF DVT AFTER T. K. A IS MORE REFRACTORY TO BOTH TRADITIONAL AND CONTEMPORARY DRUG PROPHYLAXIS

L. M. W. H OR FRACTIONAL MORE BINDING TO ANTI- THROMBIN III THAN CONVENTIONAL HEPARIN SO MORE EFFECT TO DVT PREVENTION IN T. J. A

HEPARIN INDUCED THROMBOCYTOPENIA (HIT) AND DEVASTING COMPLICATION OF ALL FORM OF HEPARIN UNCOMMON 2.6 % IN CONVENTIONAL- H 0.2 % IN L. M. W. H

FONDAPARINUX IS SYNTHETIC PENTASACCHARIDE BIND ONLY TO THE ANTI - THROMBIN III HEPARIN SITE AND HAD NO RISK OF HIT

ENOXAPARIN PROPHYLAXIS POWER, REDUCE V.T RATES FROM 28% TO 6%

RIVAROXABAN IN 2011 APPROVED BY FOOD & DRUG ADMINISTRATION REDUCE OVERALL DVT & ALL CAUSE MORTALITY. RATE UNDER 7% (IN 3148 T. K. A) 31.4% REDUCTION COMPARED WITH ENOXAPARIN

RIVAROXABAN 1- NEED NO MONITORING 2- METABOLIZE IN LIVER 3- ONLY ORAL USE mg DAILY 5- NO BLEEDING EVIDENT MORE THAN ENOXAPARIN

− V. T OF CALF MANAGE WITH 6 WEEKS PERIOPERATIVE OF WARFARIN − PROXIMAL DVT WITH 12 WEEK WARFARIN − P. E WITH 3- 6 MONTHS − THERAPEUTIC (INR 2- 3) WARFARIN AFTER INITIAL ANTICOAGULATION WITH L. M. W. H MORE RECENTLY IN THE ERA OF L. M. W. H, IMMEDIATE OUTPATIENT TREATMENT OF V. T HAS BECOME POPULAR

HOW EVER, IN POSTOPERATIVE PATIENT WITH A SBSTANTIAL ATTENDANT RISK OF BLEEDING, INITIATION OF ANTICOAGULATION AS AN INPATIENT FOLLOWED BY OUT PATIENT THERAPY AFTER ANTICOAGULANT DOSING AND INTENSITY HAVE BEEN STABILIZED IS A MORE PRUDENT APPROACH

JBJS 2013/ 1/ T. J. A 5- YEAR 90 DAY FOLLOWED NO DIFFERENCE BETWEEN ASPIRIN AND L. M. W. H IN: T. E COMPLICATION P. E MORTALITY CONFIDENCE INTERVAL MAJOR HEMORROGE

COMBINED MECHANICAL & DRUG FOR 10- DAY AFTER T. K. A IS MORE EFFECTIVE

MORE PATIENT OF ASPIRIN GROUP MORE RETURN TO THEATER FOR WOUND COMPLICATION

CHARNLEY & CO T. J. A 11 YEARS 1- PE: 8% 2- FATAL CASES 1% IN T. J. A WITHOUT PROPHYLAXIS DVT 84% CLINICALLY P.E 1.7% FATAL CASE OVERALL: IPC + L. M. W.H IS BETTER OF IPC + ASPIRIN OR WARFARIN

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