Perioperative Deep Vein Thrombosis in Elderly Patients with Lower Extremity Fracture: A Comprehensive Review of Anesthetic Management Strategies

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Abstract
Elderly patients with lower extremity fractures are at high risk for deep vein thrombosis (DVT) and its potentially fatal complication, pulmonary embolism. As perioperative physicians, anesthesiologists serve pivotal roles in mitigating thrombosis risk and optimizing patient outcomes, thus requiring a comprehensive understanding of the pathophysiology and management of DVT in this vulnerable population. Despite its significant clinical importance, comprehensive literature on perioperative DVT management for elderly patients with lower extremity fractures remains scarce. This review synthesizes evidence regarding epidemiology, pathophysiology, diagnostic challenges, multimodal prevention strategies for fracture-related thrombosis, and specific anesthetic considerations for this vulnerable population. It emphasizes the importance of routine preoperative Doppler ultrasonography and early DVT prevention. Besides pharmacological prevention, physical prevention and early mobilization constitute essential DVT prophylaxis components. Anesthesiologists must judiciously weigh thromboprophylaxis benefits against hemorrhage risks while addressing the inherent conflict between preoperative comorbidity optimization and timely surgical intervention, striving to perform surgery within 48 h after injury. Intraoperatively, neuraxial anesthesia should be preferred in the absence of contraindications, and anticoagulation and effective analgesia should be resumed early postoperatively to facilitate early mobilization. Through rigorous evaluation of contemporary literature and clinical practice, this review delivers evidence-based recommendations to enhance clinical decision-making and improve perioperative anesthesia management for this high-risk population.

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