Warwick_edit.qxp 28/9/07 12:46 Page 50
Orthopaedic Surgery
randomised trial is only as reliable as the unitary hypothesis studied and method should be used until the bleeding risk is lessened; an effective
the exclusion criteria applied to the studied sample. In this author’s view, chemical can be safely started and continued for as long as there is a risk
clinicians should regard randomised trials and meta-analysis as showing of thrombosis.
the general direction rather than being the constraining basis of practice.
The combined literature, as well as a pragmatic view, would support a Uncertain Delay to Surgery
combination of mechanical and chemical methods.
51,52
If the time of surgery is uncertain, such as for hip fracture and trauma
patients, the mechanical method can be started as close to the moment
Particularly High Risk of Thromboembolism of trauma as possible and continued until such time after surgery as the
For those patients with previous thrombosis, strong family history or clinician feels that a chemical can be commenced.
prolonged surgery, mechanical and chemical methods can be used
together for as long as possible. Neuraxial Anaesthesia
The risk of a spinal haematoma can be minimised by delaying the
Particularly High Risk of Bleeding administration of a chemical for at least eight hours after the catheter is
For those patients with a particularly high risk of bleeding, a mechanical removed; the interim can be safely covered with a mechanical method. ■
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50 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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