The need for prophylaxis against venous thromboembolism in high-risk patients undergoing surgery is widely accepted. Although effective and safe agents are available, a number of issues remain unresolved. These contemporary issues are addressed in this supplement, which includes the proceedings of a postgraduate course on “Contemporary Issues in Prophylaxis of Deep Vein Thrombosis,” held at the American College of Chest Physicians Meeting in San Diego in November 2002.
Dr. Anderson and associates discuss temporal trends in the use of prophylaxis in total hip or knee surgery between 1996 and 2001. Based on a Hip and Knee Registry of self-reported data from 464 orthopedic surgeons, the authors report that the mean length of hospital stay has decreased and is now < 4 days and that the use of spinal or epidural anesthesia has increased and is now used in approximately 50% of patients in the registry. In 2001, approximately 90% of patients received an acceptable form of prophylaxis during their hospital stay, while approximately 50% of patients received prophylaxis for > 21 days; these findings represent a small increase from the 1996 levels.