Determining the Appropriate Pharmaceutical Prophylaxis for Venous Thromboembolism Following Total Joint Arthroplasty: A Systematic Literature Review

Background: Venous thromboembolism (VTE), to include both deep vein thrombosis and pulmonary embolism, is a diagnosis with a significant clinical burden. Patients undergoing total joint arthroplasty (TJA), which encompasses total hip arthroplasty and total knee arthroplasty, are at an increased risk of developing a VTE as a postoperative complication. Current guidelines offer providers a multitude of options when selecting VTE prophylaxis interventions with no clear designation of superiority. Purpose: The purpose of this study is to guide providers, with assistance of an algorithm, in identifying the best pharmacologic modality for VTE prophylaxis of a postoperative TJA patient. A systematic review was conducted in reference to the question: in patients who received TJA, how does the use of different antithrombotic agents affect the incidence rate of VTE? Methods: A literature search was conducted utilizing CINAHL, PubMed, and Embase. Articles were included if they utilized both antiplatelets and anticoagulants, included both total hip arthroplasty and total knee arthroplasty patients, and analyzed VTE occurrence as a subject of interest. Results: It was concluded that there is no statistically significant difference between acetylsalicylic acid and anticoagulant use in the prevention of VTEs in postoperative TJA patients. An algorithm was developed based on clinical findings, medication parameters, and current guidelines to assist in determining the best antithrombotic medication for a patient. Conclusion: While VTE prophylaxis regimens are typically based on institutional guidelines or surgeon preference, the proposed algorithm can help guide providers in prescribing a treatment modality for patients who may not benefit from existing regimens.