Which scenario warrants pharmacologic DVT prophylaxis with LMWH or DOACs in orthopedic care?

• A. After minor wrist fracture
• B. After major lower-extremity fractures or joint replacements
• C. For isolated hand injuries
• D. For superficial skin infections

Answer: (B)

In orthopedic care, you reserve pharmacologic DVT prophylaxis for situations with a high risk of venous thromboembolism due to surgery or significant immobilization. Major lower-extremity fractures and joint replacements create substantial venous stasis and potential endothelial injury, two factors that markedly raise the likelihood of clot formation. Using low molecular weight heparin or a direct oral anticoagulant in the perioperative or early postoperative period helps inhibit clot development and lowers the risk of DVT and PE.

In contrast, a minor wrist fracture or isolated hand injuries involve less tissue trauma and shorter periods of immobilization, so the DVT risk is much lower; pharmacologic prophylaxis is not routinely indicated unless the patient has additional risk factors for thrombosis. Superficial skin infections do not meaningfully increase DVT risk and don’t justify prophylaxis.