Key result
Guidelines recommend 10 to 14 days of VTE prophylaxis after total hip or knee arthroplasty, though the optimal agent remains unidentified and requires shared decision-making.
Why the study?
The optimal agent for VTE prophylaxis after total hip or total knee arthroplasty has not been identified, and validated risk stratification protocols to balance thrombosis against bleeding are lacking.
What is the optimal agent for venous thromboembolism prophylaxis after total hip and knee arthroplasty?
What is the optimal agent for venous thromboembolism prophylaxis after total hip and knee arthroplasty?
Selection of VTE prophylaxis after joint arthroplasty requires shared decision-making and risk stratification to balance thrombosis prevention and bleeding risk.
Optimal VTE prophylaxis agent after THA/TKA remains unidentified; leaves open need for randomized comparisons to guide selection.
➤: 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. ➤: 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. ➤: The use of aspirin for VTE prophylaxis has increased in popularity over the past decade because it is effective, and it is an oral agent that does not require monitoring. The true efficacy of aspirin needs to be determined in multicenter randomized clinical trials. ➤: Validated risk stratification protocols are essential to identify the safest and most effective regimen for VTE prophylaxis for individual patients. There is no consensus regarding the optimal method for risk stratification; the selection of a prophylaxis agent should be determined by shared decision-making with the patient to balance the risk of thrombosis versus bleeding. ➤: Patients with atrial fibrillation being treated with chronic warfarin therapy or direct oral anticoagulants should stop the agent 3 to 5 days prior to surgery. Patients do not typically require bridging therapy prior to surgery.
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Lieberman et al. (2021) conducted a review in Venous thromboembolism after total hip and knee arthroplasty. Venous thromboembolic prophylaxis was evaluated. Guidelines recommend 10 to 14 days of VTE prophylaxis after total hip or knee arthroplasty, though the optimal agent remains unidentified and requires shared decision-making.
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