Thromboprophylaxis and orthopaedic surgery: options and current guidelines

Antithrombotic therapy remains crucial in the peri- and post-operative management of patients who undergo orthopaedic surgical procedures, particularly total joint arthroplasty (TJA) and hip fracture surgery (HFS). Optimal thromboprophylaxis is currently mandatory in most orthopaedic practices to avoid the dreaded complications of venous thromboembolism (VTE). The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis, and endothelial damage. With current advances in orthopaedic surgery, a multimodal approach to thromboprophylaxis, anaesthetic management, and post-operative convalescence have altered the risks of venous thromboembolism after TJA and HFS in the lower extremity. This article reviews the various VTE prophylactic options and current best practice guidelines for orthopaedic TJA and HFS.