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I am having an argument with my surgeon that I hope you can help me with. He wants me to have a blood thinner after my total hip replacement. I have never had any trouble with blood clots and don't expect to start now. Why do I need to take a drug that I don't want and probably don't need?

It's a well-known fact that without some type of prevention (a concept called thromboembolic prophylaxis), at least half of all patients having a total hip replacement do, in fact, develop blood clots. Those blood clots form in the legs and are called deep venous thrombosis (DVTs). The risk of heart attack or stroke is increased with blood clot formation because those blood clots can break away from the blood vessel wall and travel to those the heart or brain. Once there, the clot can block blood flow causing these serious, life-threatening problems. Other studies have shown that 90 per cent of clots that go to the lungs (and then quickly travel to the heart or brain) come from the deep venous thromboses (DVTs) in the legs. That's why today's standard of practice is to provide low-molecular-weight heparin (Coumadin or Warfarin) for all patients who are having total hip or total knee replacements. There are some disadvantages to being on a blood thinner and some patients just can't use this type of prophylaxis. For those individuals, mechanical compression is provided through a pump system. The pump keeps the blood moving rhythmically and repetitively -- no chance for a blood clot to get attached to the blood vessel wall, grow, and break off to travel to the lungs, heart, or brain. Talk with your surgeon about your concerns and options. Keep in mind he is making this recommendation on the basis of solid evidence. Without preventive measures, your risk of blood clot formation after hip replacement surgery is double what it is before surgery.

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