What's New in Venous Thromboembolic Prophylaxis Following Total Knee and Total Hip Arthroplasty? An Update

Venous thromboembolic disease (VTED) (deep venous thrombosis and pulmonary embolism) is a considerable source of morbidity and mortality following lower extremity total joint arthroplasty. The purpose of this review was to: (1) evaluate the most recent updated guidelines on thromboprophylaxis; and to (2) provide an overview and update of current modalities of VTED prophylaxis, such as pharmacological agents and mechanical compression. Although the AAOS and ACCP guidelines have not changed since the last review, the SCIP guidelines have focused on implementing the concepts proposed by each of these organizations. Specifically, the use of aspirin has been highlighted as an acceptable chemoprophylactic agent. Warfarin and low molecular weight heparin remain widely used, but maintaining therapeutic levels of warfarin remains a challenge, and LWMH has not shown itself to be superior to any of the other chemoprophylactic agents. The newer oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, may have superior efficacy, but their safety profile must be studied further. Additionally, the use of mechanical prophylaxis continues to rise in popularity because of their ability to minimize bleeding complications. Future research should emphasize the development of prophylactic modalities that maximize efficacy while minimizing the risk of adverse events.