Profilassi antitromboembolica nel trauma scheletrico maggiore. Il punto di vista dell’ortopedico

Deep Vein Thrombosis (DVT) and pulmonary embolism (PE) are important complications of major skeletal trauma and polytrauma that may occur after variable time following trauma and its treatment. A variety of risk factors including the complexity of fractures and associated injuries predispose these patient to DVT and PE. Hence, early and aggressive pharmacological prophylaxis must be carried out in this setting. Thromboprophylaxis needs to be balanced against the risk of haemorrhage. It could be useful to adopt a system to stratify the risk of thromboembolism in trauma patients and select the best option for an adequate prophylaxis. The available pharmacological agents include low-dose heparin, low molecular weight heparin, and factor Xa inhibitors. Mechanical prophylaxis methods include graduated compression stockings, pneumatic compression devices, and A-V foot pumps. Caval filters are an option in high-risk patients in whom pharmacological prophylaxis is contraindicated. All these prophylactic methods are reviewed.