Venous Thromboembolism Risk in Orthopedic Patients with Cardiac Comorbidities: Narrative Review

• DOI: https://doi.org/10.22533/at.ed.1594892401101

• Palavras-chave: Venous Thromboembolism; Orthopedic Surgery; Cardiac Comorbidities; Anticoagulants

• Keywords: Venous Thromboembolism; Orthopedic Surgery; Cardiac Comorbidities; Anticoagulants

• Abstract: INTRODUCTION Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a significant risk in orthopedic patients, especially those with cardiac comorbidities. These patients are at higher risk due to immobility, endothelial injury, and hypercoagulability, exacerbated by their cardiac conditions. The review focuses on the complex interplay between orthopedic surgery, cardiac diseases, and VTE, discussing the challenges of anticoagulation management and the outcomes associated with VTE in this vulnerable population. OBJETIVE To explore and critically analyze the current understanding of venous thromboembolism (VTE) risk in orthopedic patients with cardiac comorbidities, focusing on the pathophysiology, challenges in anticoagulation management, and the efficacy of thromboprophylaxis strategies in this high-risk population. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Venous Thromboembolism” AND “Orthopedic Surgery” AND “Cardiac Comorbidities” OR “Anticoagulation Management” OR “Thromboprophylaxis” in the last  years. RESULTS AND DISCUSSION Orthopedic patients with cardiac comorbidities face multiple risk factors for VTE, including venous stasis from immobility, endothelial injury during surgery, and a hypercoagulable state. Conditions such as heart failure and atrial fibrillation further increase VTE risk. Anticoagulation strategies, including LMWH and DOACs, are critical for thromboprophylaxis but must be carefully managed to prevent bleeding complications. Mechanical prophylaxis and early mobilization are essential but are often delayed in cardiac patients, heightening their risk. The long-term prognosis in these patients is often poor, with higher rates of VTE recurrence and increased mortality. Novel anticoagulants offer promise but require further research in patients with complex cardiac conditions. CONCLUSION VTE remains a significant risk in orthopedic patients with cardiac comorbidities. The management of VTE in this population is complex, requiring a balance between thromboprophylaxis and bleeding prevention. Current guidelines provide a foundation, but further research is needed to optimize outcomes for this high-risk group. A multidisciplinary approach is crucial for managing the intricate challenges posed by both orthopedic and cardiac conditions in these patients.Venous Thromboembolism Risk in Orthopedic Patients with Cardiac Comorbidities: Narrative Review