TKA Symposium (P Sancheti, Section Editor)

Current Reviews in Musculoskeletal Medicine

, Volume 7, Issue 2, pp 108-116

First online:

Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Arthroplasty: Changing Trends

  • Nicolaas C. BudhiparamaAffiliated withNicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital Email author 
  • , Matthew P. AbdelAffiliated withDepartment of Orthopedic Surgery, Mayo Clinic
  • , Nadia N. IfranAffiliated withNicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital
  • , Sébastien ParratteAffiliated withDepartment of Orthopedics and Traumatology, St. Marguerite Hospital

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Abstract

Venous thromboembolism (VTE) has been identified as an immediate threat to patients undergoing major orthopedic procedures such as total hip arthroplasty (THA) and total knee arthroplasty (TKA). Given the known dangers of VTE, arthroplasty surgeons are sensitive to the need for VTE thromboprophylaxis. However, the modalities of thromboprophylaxis used to minimize the risks to patients have been variable. Clinical practice guidelines have been published by several professional organizations, while some hospitals have established their own protocols. The 2 most popular guidelines are those published by the Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP), both from North America. Prior to 2012, these recommendations varied depending on underlying definitions, methodology, and goals of the 2 groups. For the first time, both groups have similar recommendations that focus on minimizing symptomatic VTE and bleeding complications. The key to determining the appropriate chemoprophylaxis for patients is to balance efficacy of a prophylactic agent, while being safe in regards to bleeding complications. However, a multimodal approach that focuses on early postoperative mobilization and the use of mechanical prophylaxis, in addition to chemoprophylaxis, is essential.

Keywords

Venous thromboembolism (VTE) Deep vein thrombosis (DVT) Pulmonary embolism (PE) Thromboprophylaxis Total joint arthroplasty Clinical guidelines Mechanical prophylaxis Chemical prophylaxis Hip Knee Prophylaxis