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Venous Thromboembolism Chemoprophylaxis in Total Hip and Knee Arthroplasty

A Critical Analysis Review

Trivedi, Nikunj N., MD1; Fitzgerald, Steven J., MD1; Schmaier, Alvin H., MD1; Wera, Glenn D., MD2

doi: 10.2106/JBJS.RVW.18.00010
Review Articles with Critical Analysis Component
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Disclosures

  • * 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.

1University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio

2MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio

E-mail address for G.D. Wera: gwera@yahoo.com

Investigation performed at University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, and MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio

Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJSREV/A406).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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