Venous Thromboembolism Chemoprophylaxis in Total Hip and Knee Arthroplasty

* 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.