Extended thromboprophylaxis after hip or knee replacement

Early discharge from the hospital after total joint arthroplasty has increased the need for extended outpatient thromboprophylaxis. Multiple controlled clinical trials and several meta-analyses of these data have examined various agents in different regimens. These data indicate that extended prophylaxis with a low-molecular-weight heparin after knee or hip arthroplasty significantly reduces the number of venous thromboembolic episodes with no increases in major bleeding. The data also show that > 98% of patients given long-term low-molecular-weight heparin prophylaxis remain free from symptomatic deep venous thrombosis and pulmonary embolism. Therefore, to minimize patient risk safely and cost-effectively, extended prophylaxis with low-molecular-weight heparin once-daily for 4 weeks after surgery should be considered for patients undergoing total joint arthroplasty.