DVT Prevention
Deep vein thrombosis (blood clots) prevention after orthopedic surgery. Risk factors, prophylaxis, and warning signs.
What DVT is
A deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, usually in the leg. After hip or knee replacement, or after major lower-extremity trauma, blood flow in the legs slows because of immobility, vessel injury, or the inflammatory response to surgery. Slower blood flow favors clot formation. Most DVTs are asymptomatic and resolve on their own. But some grow and break apart, sending the clot floating up to the lungs where it can lodge in the pulmonary artery—a life-threatening pulmonary embolism (PE).
Highest-risk surgeries at OSI
DVT risk is highest after:
- Total hip replacement. One of the highest-risk surgeries. Risk is 5–10% without prophylaxis.
- Total knee replacement. Also high-risk. Risk is 5–10% without prophylaxis.
- Hip fracture surgery (especially ORIF). Combines surgery, trauma, and immobility.
- Tibia fracture surgery and other lower-extremity trauma requiring operative fixation.
Risk is lower after shoulder, wrist, and upper-extremity surgery.
DVT prophylaxis strategies
Early walking. The single most effective strategy. Getting patients up and moving within hours of surgery dramatically reduces clot risk. That’s why surgeons push weight-bearing and mobilization so aggressively after joint replacement.
Mechanical compression. Sequential compression devices (SCDs) are boots that inflate and deflate around the calves, creating a gentle pumping action that keeps blood moving. Used in the hospital and sometimes at home after discharge.
Chemical prophylaxis. Blood-thinning medications including:
- Aspirin, the mildest option.
- Enoxaparin (Lovenox), a low-molecular-weight heparin given by injection.
- Rivaroxaban (Xarelto) or apixaban (Eliquat), oral anticoagulants.
- Warfarin (Coumadin), an older oral anticoagulant requiring INR monitoring.
The choice depends on the surgery type, patient age, kidney function, and bleeding risk. Prophylaxis typically continues for 10–35 days after discharge.
Warning signs of DVT
If you develop any of these symptoms after orthopedic surgery, contact your surgeon or seek medical attention:
- Unilateral leg swelling — one leg noticeably more swollen than the other.
- Calf pain or tenderness — pain with walking or when pressing on the calf.
- Warmth or redness over the affected calf.
- Chest pain or shortness of breath — possible signs of pulmonary embolism. Call 911.
Diagnosis and treatment if DVT occurs
If DVT is suspected, an ultrasound (duplex scan) is ordered to confirm the clot. If found, you will be started on anticoagulation to prevent the clot from growing and breaking apart. Most DVTs are treated with anticoagulation alone and resolve. Some require more aggressive intervention. The key is early detection, which is why your surgeon asks you to report any concerning leg symptoms.