A 65-year-old man with mild congestive heart failure is scheduled to receive total hip replacement. He has no other underlying diseases and no history of hypertension, recent surgery, or bleeding disorder. Which of the following is the best approach to prevention of pulmonary embolus in this patient?A. Aspirin 75 mg/d
Effective prophylaxis against DVT in the high-risk setting (eg, after major orthopedic surgery of the hip or knee) requires pharmacologic treatment with unfractionated heparin, low-molecular-weight heparin, fondaparinux, or therapeutic doses of warfarin. These treatments, when given at approved dosages and time intervals, decrease the risk of radiographic DVT by over 50%; dosage guidelines should be carefully followed. Aspirin alone is not effective in prevention of pulmonary embolus. Early ambulation, sequential compression devices, and elastic stockings provide some additional benefit, but are not adequate in themselves in this high-risk situation.