Pharmacological methods for venous thromboembolism prophylaxis in arthroplasty require individualized selection based on efficacy, complication profile, and cost.
What are the advantages and limitations of various pharmacological methods for venous thromboembolism prophylaxis in patients undergoing total hip and knee arthroplasty?
Surgeons must individualize VTE prophylaxis in arthroplasty based on efficacy, complications, cost, and patient compliance.
* Numerous pharmacological methods of venous thromboembolism prophylaxis are currently utilized, each with advantages and limitations. * Warfarin has long been demonstrated to have efficacy, but has variable patient response and requires outpatient monitoring. Low-molecular-weight heparins also have long been demonstrated to have established efficacy, but require outpatient subcutaneous injections, which raises concern for compliance. Factor-Xa and direct thrombin inhibitors may be taken orally but lack easily obtainable reversal agents. * Aspirin is an appealing choice because it is inexpensive, is taken orally, requires no laboratory monitoring, and may have similar efficacy; however, it still lacks appropriately powered randomized controlled trials to substantiate its efficacy. * A surgeon must consider the efficacy, complication profile, and cost in the setting of patient competence and compliance on a case-by-case basis when choosing a prophylactic agent.
Trivedi et al. (Tue,) conducted a review in Venous thromboembolism in total hip and knee arthroplasty. Venous thromboembolism chemoprophylaxis was evaluated. Pharmacological methods for venous thromboembolism prophylaxis in arthroplasty require individualized selection based on efficacy, complication profile, and cost.