Effective thromboprophytaxis administered close to the time of major orthopedic surgery: a review.

As major orthopedic surgery poses a high risk for venous thromboembolic disease, use of thromboprophylaxis has become routine in this setting. Unfortunately, there is still no consensus regarding optimal time to initiate thromboprophylaxis. Results from several studies indicate the importance of timing to the efficacy and safety of thromboprophylaxis. As thrombogenesis is thought to begin perioperatively, "just-in-time" thromboprophylaxis has been proposed-antithrombotic therapy with low-molecular-weight heparins initiated soon before or soon after surgery. Results from our large clinical trial show the efficacy and safety of a modified dalteparin regimen administered close to the time of total hip arthroplasty.