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

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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.

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Acknowledgments

The authors did not receive any outside funding or grants in support of their research for or in preparation of this work. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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Conflict of Interest

Nicolaas C. Budhiparama is a consultant for DePuy J&J Stryker, Sanofi Aventis, Pfizer Asia and Bayer. He has received a research grant from Bayer; education grants from DePuy J&J Stryker, Pfizer, and Zimmer.

Matthew P. Abdel declares that he has no conflict of interest.

Nadia N. Ifran declares that she has no conflict of interest.

Sébastien Parratte has received payment for development of educational presentations from Zimmer.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital, Jl. Jend. Gatot Subroto Kav. 59, Jakarta, 12950, Indonesia

    Nicolaas C. Budhiparama & Nadia N. Ifran

  2. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA

    Matthew P. Abdel

  3. Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France

    Sébastien Parratte

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  1. Nicolaas C. Budhiparama
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Correspondence to Nicolaas C. Budhiparama.

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Budhiparama, N.C., Abdel, M.P., Ifran, N.N. et al. Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Arthroplasty: Changing Trends. Curr Rev Musculoskelet Med 7, 108–116 (2014). https://doi.org/10.1007/s12178-014-9207-1

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