When I had my total knee replacement done, the orthopedic surgeon put me on a blood thinner to help prevent clots. I’m facing possible surgery on my ankle now because of a fracture that healed wrong. Will they automatically put me on those blood thinners again? I really don’t like to be taking anything like this.

Orthopedic surgery of any kind affecting the lower extremity carries with it the risk of a blood clot called deep venous thrombosis (DVT). An even greater concern is if that clot breaks off and travels to the lungs causing a pulmonary embolism (PE). It could also go to the brain, which is called a cerebral venous thrombosis.

Each of these possible problems must be avoided because of the potential final result: loss of blood to the leg requiring amputation, stroke, and even death. Taking blood thinners before or after surgery is preventive or prophylactic therapy.

Studies show the risk of clots is much higher for hip or knee replacement compared to an ankle fracture. Not everyone having ankle surgery needs prophylaxis for blood clots. But there are some individual patient risk factors that can tip the scales in favor of this valuable treatment approach.

For example, anyone with diabetes (especially diabetes with complications such as delayed wound healing or infections) or peripheral vascular disease (PVD; poor blood circulation) should be considered for prophylactic management of clots.

The potential consequences of a blood clot should always be taken into consideration. You may not even need this kind of preventive care, but it is a good question to ask your surgeon when you go in for your pre-operative work-up.