Key Points
ÎTotal hip arthroplasty (THA) and total knee arthroplasty (TKA) are performed with increasing frequency, with close to 200,000 procedures for THA alone in the United States each year.
ÎThe risk for venous thromboembolism (VTE) in major orthopedic surgery, in particular THA and hip fracture surgery (HFS), is among the highest for all surgical specialties, and deaths from VTE still occur, albeit very infrequently.
Treatment Joint Replacement Surgery
ÎIn patients undergoing THA or TKA, the American College of Chest Physicians (ACCP) recommends use of one of the following for a minimum of 10 to 14 days rather than no antithrombotic prophylaxis: low-molecular-weight heparin (LMWH), fondaparinux, apixabana
, dabigatranb , rivaroxaban, low-dose
unfractionated heparin (LDUH), adjusted-dose vitamin K antagonist (VKA), aspirin (all 1B), or an intermittent pneumatic compression device (IPCD) (1C).
ÎIn patients undergoing THA or TKA, irrespective of the concomitant use of an IPCD or length of treatment, the ACCP suggests the use of LMWH in preference to the other agents recommended as alternatives: fondaparinux, apixabana
, dabigatranb aspirin (all 2C). Hip Fracture Surgery (HFS)
ÎIn patients undergoing HFS, rather than no antithrombotic prophylaxis the ACCP recommends use of one of the following for a minimum of 10 to 14 days: LMWH, fondaparinux, LDUH, adjusted-dose VKA, aspirin (all 1B), or an IPCD (1C).
ÎIn patients undergoing HFS, irrespective of the concomitant use of an IPCD or length of treatment, the ACCP suggests the use of LMWH in preference to the other agents recommended as alternatives: fondaparinux, LDUH (2B), adjusted-dose VKA, or aspirin (all 2C).
, rivaroxaban, LDUH (all 2B), adjusted-dose VKA, or
a
Apixaban was not FDA approved in the United States at the time of the guideline publication. b Not FDA-approved for VTE prevention.
