Thromboembolism prophylaxis in orthopaedic surgery and trauma

Area of Science:

• Orthopaedic Surgery
• Pharmacology
• Vascular Medicine

Background:

• Thromboembolism prophylaxis is standard in major orthopedic procedures like hip/knee arthroplasty and hip fracture surgery.
• Low-molecular-weight heparins (LMWHs) are frequently used, but direct-acting anticoagulants (DOACs) are increasingly adopted for certain surgeries.
• Aspirin is also an option for low-risk hip/knee arthroplasty patients in the US.

Purpose of the Study:

• To review current practices and agent choices for thromboembolism prophylaxis in various orthopedic surgeries.
• To highlight the distinctions in prophylaxis recommendations based on surgical complexity and patient risk.
• To inform clinical decision-making regarding anticoagulant selection in orthopedic surgery.

Main Methods:

• Review of established guidelines and recent literature on thromboembolism prophylaxis in orthopedic surgery.
• Analysis of anticoagulant options, including LMWHs, DOACs, and aspirin, for different surgical scenarios.
• Consideration of patient-specific risk factors and surgical characteristics influencing prophylaxis choice.

Main Results:

• LMWHs are the primary agents for major orthopedic surgery, with DOACs approved for most but not hip fracture surgery.
• Aspirin is a viable option for low-risk hip and knee arthroplasty patients in the United States.
• For less complex procedures (e.g., lower leg, foot, ankle, knee arthroscopy, arm, spine surgery), prophylaxis requires individualized assessment, with LMWHs preferred as DOACs lack approval.

Conclusions:

• Thromboembolism prophylaxis strategies must be tailored to the specific orthopedic procedure and patient risk profile.
• While LMWHs remain a cornerstone, the role of DOACs and aspirin is expanding in specific orthopedic contexts.
• Individualized risk assessment is crucial for optimizing prophylaxis in lower-risk orthopedic surgeries where DOACs are not indicated.