Venous thromboembolic prophylaxis following total hip arthroplasty: a North American perspective

Patients undergoing total hip arthroplasty are at risk for venous thromboembolic disease, including deep venous thrombosis, pulmonary embolism, and postphlebitic syndrome. The incidence of these complications has declined as a result of recent advances in surgical procedures, early postoperative patient mobilization, and prophylactic alternatives. This paper reviews the benefits and disadvantages of current mechanical and pharmacologic thromboprophylactic alternatives, as well as the prophylactic effects of different anesthesia techniques and of presurgical autologous blood donation. The pharmacologic agents that are widely used in North America today include aspirin, warfarin, and low-molecular-weight heparins. The low-molecular-weight heparins-enoxaparin and dalteparin-have recently gained increasing acceptance among orthopedic surgeons. The effectiveness and safety of extending prophylaxis beyond the time of hospital discharge are also discussed. It is concluded that the optimal thromboprophylactic regimen is one that is customized, adjusted according to each patient's risk factors and other characteristics.