Prevention of deep venous thrombosis in ambulatory or discharged orthopaedic patients. Actual management.

In recent years the problem of deep venous thrombosis (DVT) in outpatients and discharged patients has grown into a medical and juridical problem. In traumatology certain recommendations and statistical material exist: similar recommendations were made by the Berufsverband der Arzte für Orthopädie, Germany, pointing out the lack of sufficient statistical material. With the present study we tried to evaluate the actual management of DVT in discharged patients or outpatients in leading orthopaedic hospitals. The results from December 1993 reveal an inhomogeneous procedure which does not precisely follow the above recommendations. However, most orthopaedic surgeons agree that either general or individual means to prevent DVT should be available for ambulatory and discharged patients with plaster immobilisation of the leg according to presently accepted standards, i.e. low-dose heparin or low-molecular-weight heparins. Reduced weight-bearing, in contrast, is considered not to require preventive heparinisation to any great extent.