The Current Status of Venous Thromboembolism Prophylaxis Following Total Joint Arthroplasty

Background: A variety of local and systemic factors contribute to the increased risk of venous thromboembolism (VTE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA). The optimal regimen(s) for VTE prophylaxis are not conclusively defined at the present. This review is focused on the most current data on the outcomes of using various VTE prophylaxis following TKAs and THAs in the United State (U.S.) Methods: A review of the literature over the past 5 years was undertaken. We in particular focused on the data comparing the efficacy and the safety of different agents. Results: The commonly used VTE prophylaxis agents in the U.S. include: low-molecular-weight heparin, the new oral anticoagulants (factor Xa inhibitors), warfarin, and aspirin. Aspirin in particular has gained popularity over the past few years. This is principally due to several factors: less bleeding, equal efficacy, and the ease of use. Most surgeons use a “multi-modal” protocol including early mobilization, mechanical prophylaxis, and chemoprophylaxis. Conclusion: There is no conclusive evidence with regard to what agent(s) are the most efficacious and the safest in VTE prophylaxis following TKAs and THAs. There is however general agreement between the major guidelines from the professional associations of orthopedic surgery, and from the non-orthopedic disciplines. It is important to risk-stratify each patient, and to apply the most appropriate VTE prophylaxis.