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July 1996

Invited Commentary

Author Affiliations

University of Texas Dallas

Arch Surg. 1996;131(7):698. doi:10.1001/archsurg.1996.01430190020004

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Although the incidence of postoperative venous thromboembolism occurring after hospital discharge is uncertain, the magnitude of this problem is likely to increase. The emphasis on early hospital discharge and outpatient procedures with home recovery leaves many patients vulnerable to a complication that in the past was addressed with aggressive in-hospital prophylaxis. Thousands of general and orthopedic surgery patients have been studied in randomized trials that have firmly established the efficacy of low-dose, unfractionated heparin; low-molecular-weight heparin (LMWH); warfarin; intermittent pneumatic compression; and the use of elastic stockings in preventing venous thromboembolism. While all of these regimens seem to be successful in the management of general surgery patients, orthopedic patients require strong prophylaxis and are optimally protected with LMWH or warfarin. However, these data, largely obtained during the 1970s and 1980s when hospital stays were longer, may not be fully reliable when applied to contemporary medical practice. Venous thromboembolic endpoints in

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