What combination is considered effective DVT prophylaxis after major orthopedic procedures?

• A. Pharmacologic prophylaxis with LMWH or DOACs alone
• B. Mechanical methods alone
• C. Pharmacologic prophylaxis with LMWH or DOACs plus mechanical methods
• D. No prophylaxis

Answer: (C)

After major orthopedic surgery, the risk of DVT is high because of vein injury, inflammation, and limited mobility. The most effective approach combines pharmacologic prophylaxis with mechanical methods. Using a drug that dampens the coagulation cascade, such as low-molecular-weight heparin or a direct oral anticoagulant, helps prevent clot formation. Adding mechanical measures—like intermittent pneumatic compression or graduated compression stockings—improves venous return and reduces stasis in the legs. Together, they address two different pathways that lead to clots, providing greater protection against DVT and pulmonary embolism than either strategy alone. This combined approach is standard unless there are specific contraindications to anticoagulation or bleeding risk that would necessitate relying on mechanical methods alone.