Venous Thromboembolic Prophylaxis After Total Hip and Knee Arthroplasty

Abstract

ä The selection of an agent for prophylaxis against venous thromboembolism (VTE) is a balance between efficacy and safety. The goal is to prevent symptomatic VTE while limiting the risk of bleeding.ä The optimal agent for VTE prophylaxis has not been identified. The American College of Chest Physicians guidelines recommend that, after total hip or total knee arthroplasty, patients receive at least 10 to 14 days of 1 of the following prophylaxis agents: aspirin, adjusted-dose vitamin K antagonist, apixaban, dabigatran, fondaparinux, low-molecular-weight heparin, low-dose unfractionated heparin, rivaroxaban, or portable home mechanical compression. Venous Thromboembolic Prophylaxis GuidelinesIn 2011, the American Academy of Orthopaedic Surgeons (AAOS) released their second guideline for VTE prophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) 7 . The major focus of this guideline was the efficacy and Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G548).

Role of aspirin in the prevention of heterotopic ossification following total hip replacement: a systematic review and meta‐analysis

“…12,28,41 It is inexpensive and safe, sparing the need for a routine blood examination. 42 There is a growing body of literature that recognizes the effectiveness and safety of ASA therapy in minimizing VTE following arthroplasty. 42 Due to the limited number of studies and their inconsistent results, so far, whether or not ASA can play a role in reducing HO formation after THA, another beneficial effect of ASA, has yet to be elucidated.…”

“…42 There is a growing body of literature that recognizes the effectiveness and safety of ASA therapy in minimizing VTE following arthroplasty. 42 Due to the limited number of studies and their inconsistent results, so far, whether or not ASA can play a role in reducing HO formation after THA, another beneficial effect of ASA, has yet to be elucidated. Quite a few comprehensive reviews and meta-analyses were previously conducted to evaluate existing prophylactic strategies for HO.…”

Iliopsoas Hematoma After Total Hip Arthroplasty Using a Minimally Invasive Modified Direct Anterior Approach

“…Current evidence is unclear about which prophylactic strategy (strategies) is (are) optimal or suboptimal against venous thromboembolism. The use of a multimodal protocol, including early mobilization, mechanical prophylaxis, and chemoprophylaxis, as prescribed in all our patients undergoing arthroplasty, is widely accepted 7 . After this incident, shifting our chemoprophylaxis from subcutaneous enoxaparin to oral agents, such as aspirin or apixaban, seems a safer strategy.…”

“…1-B). Ten hours after surgery, the patient started walking using a walker, referring mild pain on the incision site, and according to the thromboembolic prophylaxis therapy guidelines 7 , 40 mg subcutaneous enoxaparin was initiated 12 hours postoperatively. A postoperative blood test showed a decrease of 1.4 g/dL of hemoglobin (hemoglobin: 13.5-12.1 g/dL; hematocrit: 29.6%) and normal coagulation (prothrombin time: 12.35 seconds; international normalized ratio: 1.0 and 180,000 platelets).…”

Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

“…A large amount of evidence shows that prophylactic anticoagulation therapy after THA in the ERAS protocol can effectively reduce the risk of postoperative VTE. However, the optimal anticoagulation drug protocol is still controversial [7][8]. Low Molecular Weight Heparin (LMWH), Fondaparinux (FPX) and Rivaroxaban are commonly used drugs to prevent VTE after THA.…”