Abstract:

Venous thromboembolic disease remains a serious complication following lower extremity total joint arthroplasty. Postoperative thromboembolic complications, which include symptomatic deep vein thrombosis, bleeding, and pulmonary embolus, are recognized causes of patient morbidity, mortality, increased length of stay, and higher healthcare costs. Various thromboprophylaxis guidelines have been recommended to prevent and thereby reduce the incidence of such events. However, despite various studies exploring prophylaxis measures, the incidence of venous thromboembolic events has remained relatively unchanged over the past 10 years. We therefore aimed to: (1) evaluate the current 2011 American Academy of Orthopaedic Surgeons (AAOS) and the 2012 American College of Chest Physicians (ACCP) recommendations concerning venous thromboembolic disease after lower extremity joint arthroplasty; and (2) report on different modalities of prophylaxis, specifically, pharmacological agents, mechanical compression devices, and inferior vena cava filters. Both AAOS and ACCP guidelines recommend a combined approach with mechanical compression devices and pharmacological prophylaxis. A major difference is that the AAOS work group does not recommend specific pharmacological agents, whereas the ACCP guidelines give specific recommendations. Additionally, routine primary thromboprophylaxis with inferior vena cava filters is only recommended when there are contraindications to anticoagulation therapy.

Authors:

Bhaveen H. Kapadia, MD, Orthopedic Research Fellow, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Kimona Issa, MD, Orthopedic Research Fellow, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, Robert Pivec, MD, Orthopedic Research Fellow, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland Michael A. Mont, MD , Co-Director, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Associate Professor, Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

PMID: 23292672

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