Assessment of thromboembolic risk and preventive strategies in major orthopaedic surgery

Introduction: Venous thromboembolic disease (VTD), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), was one of the main causes of preventable mortality in hospitalized patients. Its incidence increased significantly in those who underwent hip (THA) and knee (TKA) arthroplasty, which led to the development of effective prevention strategies. Development: Risk factors associated with both the patient and the surgical procedure were identified. The Caprini scale was used to stratify them, including in orthopedic patients. In terms of pharmacological prophylaxis, anticoagulants such as low molecular weight heparins (LMWH), direct oral anticoagulants (DOAC) and aspirin (ASA) were compared. Different studies showed that ASA was similarly effective to LMWH in low-risk patients, with advantages such as lower cost and better tolerance. However, DOACs offered a slight superiority in efficacy, although with a higher risk of bleeding. Current recommendations favored a combination of pharmacological and mechanical measures such as early ambulation and the use of compression stockings. Conclusion: The prevention of VTE in major orthopedic surgery required an individualized and evidence-based approach. Aspirin emerged as a valid alternative in certain cases, without completely replacing other anticoagulants in high-risk patients. Further research was considered essential, especially in local contexts such as Argentina, to adapt strategies according to the needs of the health system.