Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug 18;103(16):1556-1564.
doi: 10.2106/JBJS.20.02250.

Venous Thromboembolic Prophylaxis After Total Hip and Knee Arthroplasty

Jay R Lieberman  1 , Jennifer A Bell
Affiliations
Review

Venous Thromboembolic Prophylaxis After Total Hip and Knee Arthroplasty

Jay R Lieberman et al. J Bone Joint Surg Am. .

Abstract

➤: The selection of an agent for prophylaxis against venous thromboembolism (VTE) is a balance between efficacy and safety. The goal is to prevent symptomatic VTE while limiting the risk of bleeding.

➤: The optimal agent for VTE prophylaxis has not been identified. The American College of Chest Physicians guidelines recommend that, after total hip or total knee arthroplasty, patients receive at least 10 to 14 days of 1 of the following prophylaxis agents: aspirin, adjusted-dose vitamin K antagonist, apixaban, dabigatran, fondaparinux, low-molecular-weight heparin, low-dose unfractionated heparin, rivaroxaban, or portable home mechanical compression.

➤: The use of aspirin for VTE prophylaxis has increased in popularity over the past decade because it is effective, and it is an oral agent that does not require monitoring. The true efficacy of aspirin needs to be determined in multicenter randomized clinical trials.

➤: Validated risk stratification protocols are essential to identify the safest and most effective regimen for VTE prophylaxis for individual patients. There is no consensus regarding the optimal method for risk stratification; the selection of a prophylaxis agent should be determined by shared decision-making with the patient to balance the risk of thrombosis versus bleeding.

➤: Patients with atrial fibrillation being treated with chronic warfarin therapy or direct oral anticoagulants should stop the agent 3 to 5 days prior to surgery. Patients do not typically require bridging therapy prior to surgery.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G548).

References

    1. Lieberman JR, Cheng V, Cote MP. Pulmonary embolism rates following total hip arthroplasty with prophylactic anticoagulation: some pulmonary emboli cannot be avoided. J Arthroplasty. 2017 Mar;32(3):980-6. Epub 2016 Sep 28.
    1. Cote MP, Chen A, Jiang Y, Cheng V, Lieberman JR. Persistent pulmonary embolism rates following total knee arthroplasty even with prophylactic anticoagulants. J Arthroplasty. 2017 Dec;32(12):3833-9. Epub 2017 Jul 5.
    1. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2)(Suppl):e278S-325S.
    1. Bayley E, Brown S, Bhamber NS, Howard PW. Fatal pulmonary embolism following elective total hip arthroplasty: a 12-year study. Bone Joint J. 2016 May;98-B(5):585-8. Epub 2016/05/05.
    1. Lieberman JR, Pensak MJ. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am. 2013 Oct 2;95(19):1801-11.

MeSH terms

Substances