Venous thromboembolism prophylaxis in orthopedic surgery: a narrative review

Venous thromboembolism (VTE) is a major complication of orthopedic surgery and can lead to complications including pulmonary embolism, stroke, or even death. This narrative review aims to summarize current approaches to VTE prophylaxis for patients undergoing orthopedic surgery while also considering current trends in research surrounding potential updates to clinical recommendations and establishing a clear case for the role of patient-centered therapeutic approaches when looking to manage orthopedic postoperative VTE and associated complications. A narrative review was performed based on existing literature published on the topic of VTE prophylaxis in orthopedic surgery between the dates 1.1.2012 and 12.31.2023. Articles were searched for using a com- bination of four key terms combined with Boolean operators and were searched for on three major databases – Google Scholar, PubMed, and ScienceDirect. Findings were combined with and compared to recommendations from major relevant professional organizations. A wide variety of guidelines for both chemoprophylaxis and mechanical prophylaxis were considered, with findings of particular interest being support for industry-standard low-molecular-weight heparin (LMWH) and direct oral anticoagulant (DOAC) chemoprophylaxis, along with increased interest in aspirin. The evidence also supports mechanical prophylaxis in conjunction with chemoprophylaxis. Given that few validated VTE risk prediction score calculators exist, it is the recommendation of the authors to enhance risk stratification and personalized medicine by developing an orthopedic-specific risk assessment model to assist in decision-making, risk factor identification, and overall provision of comprehensive, personalized care designed to optimize quality of life and maximize management of orthopedic postoperative thromboembolic complications.