Bleeding associated with thromboprophylaxis: a multifactorial issue

Although postoperative bleeding is a legitimate concern when anticoagulant agents are used in thromboprophylaxis during total joint arthroplasty, the incidence of bleeding reported in clinical trials must be evaluated. Postoperative bleeding is a multifactorial effect that may be influenced by variables such as preoperative risk factors; the protocol, timing, and dose of the anticoagulant; and the surgical procedure and technique, as well as by the specific anticoagulant used. Because the reported rates of bleeding associated with various anticoagulants are low and the risks of venous thromboembolism in the absence of prophylaxis are high, thromboprophylaxis is a safe and effective strategy for reducing morbidity and mortality in patients undergoing total joint arthroplasty.