Multimodal Thromboprophylaxis for Total Hip and Knee Arthroplasty Based on Risk Assessment

Abstract

A multimodal thromboembolic prophylactic regimen is consistent with protecting patients while limiting adverse clinical outcomes secondary to thromboembolic, vascular, and bleeding complications.

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

“…Our data show there is a low incidence of DVT associated with the use of mechanical prophylaxis for patients undergoing elective hip surgeries, and we confirmed the results of others who reported low incidences of DVT and PE using mechanical thromboprophylaxis with IPC with or without aspirin for patients having elective hip surgery (Table 2) [4,6,12,19,26,28,29,33,34]. Moreover, none of our patients had proximal DVTs, none had fatal or symptomatic PEs, and the 6-month postoperative mortality was 0%.…”

“…Several guidelines for DVT and PE prevention have recommended anticoagulant drugs based on studies showing efficacy for reducing the incidence of DVT, including asymptomatic DVT [8,23,32]. However, mechanical thromboprophylaxis with IPC has been used for almost 20 years [19] and reportedly also has been effective as prophylaxis against DVT and PE when used in combination with other nonpharmacologic modalities with or without aspirin [4,6,12,19,26,28,29,33,34]. As IPC might be contraindicated with preoperative DVT, it is important to know the incidence of preoperative asymptomatic DVT when considering IPC for DVT and PE prophylaxis.…”

“…Several guidelines for DVT and PE prevention have recommended anticoagulant drugs based on studies showing efficacy for reducing the incidence of DVT, including asymptomatic DVT, using imaging modalities [8,13,23,32]. However, mechanical prophylaxis with intermittent pneumatic compression (IPC) in combination with other nonpharmacologic modalities such as regional anesthesia, rapid mobilization, and/or aspirin also reportedly is effective for thromboprophylaxis with 0.7% to 5.3% incidences of DVT [4,6,12,19,26,28,29,33,34]. A previous multicenter study of 3016 patients who underwent elective hip surgeries and received IPC prophylaxis without pharmacologic agents showed no patients had fatal postoperative PE, one (0.03%) had a symptomatic PE, and four (0.1%) had symptomatic DVT [31].…”

Incidence of symptomatic Venous Thrombo Embolism (VTE), with or without chemoprophylaxis, in patients undergoing Total Knee Replacement: A comparative study

“…In the group of 57 which didn't receive chemoprophylaxis, 4 patients developed DVT and 1 patient developed PE. (17,18) . In the context of public health, it is viewed as a preventable cause of morbidity and mortality.…”

Does International Normalized Ratio Level Predict Pulmonary Embolism?

“…All of these consequences can lead to reoperation and increase in morbidity and mortality. Third, pneumatic compression boots and aspirin, along with regional anesthesia, are suggested as being noninferior to chemoprophylactic anticoagulants at preventing PE without the increased bleeding complications [6]. Interestingly, potent anticoagulants such as warfarin and LMWH are associated with increased all-cause mortality rates, including PE, when compared to pneumatic compression boots and aspirin [20].…”