Current Status of Anticoagulation Therapy After Total Hip and Total Knee Arthroplasty

Postoperative venous thromboembolism in the pelvis and lower extremities is a potentially life-threatening complication in patients undergoing elective total hip and total knee arthroplasty. Numerous pharmacologic methods of prophylaxis have been used in the past with varying degrees of success. Warfarin has been proved effective as a prophylactic agent after total hip arthroplasty but has been less efficacious after total knee arthroplasty. The low-molecular-weight heparins have recently been approved for prophylaxis after total hip and total knee arthro-plasty and are an acceptable alternative to warfarin. This new class of drugs appears to have the advantage of predictable subcutaneous bioavailability, which allows less frequent administration and laboratory monitoring and offers a decrease in the occurrence of side effects.