An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

Abstract

Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6-1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

Keywords: DVT; arthroplasty; joint replacement; pulmonary embolism; surgical complications; venous thromboembolism.

Figure 1

Overall rates of venous thromboembolism (VTE), deep venous thrombosis (DVT), and pulmonary embolism (PE) after total hip arthroplasty. Data points represent values reported by individual studies at the start and end of the study period. When there was no statistically significant difference over time, the average value is shown for both the beginning and end of the study period. References: [6,9,37,38,39,42,43,44].

Figure 2

Overall rates of venous thromboembolism (VTE), deep venous thrombosis (DVT), and pulmonary embolism (PE) after total knee arthroplasty. Data points represent values reported by individual studies at the start and end of the study period. When there was no statistically significant difference over time, the average value is shown for both the beginning and end of the study period. References: [6,9,37,39,43,44,47,48].