Login Register Cart 0
Generic placeholder image

Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Prophylaxis for Venous Thromboembolic Events in Elective Total Hip and Total Knee Arthroplasty

Author(s): Theofilos Karasavvidis, Vasileios Bouris, William Xiang, Georgios Tzavellas, Nektarios Charisis, Leonidas Palaiodimos, Vassiliki Kigka, Christos V. Bourantas* and Ioannis Gkiatas

Volume 28, Issue 10, 2022

Published on: 10 May, 2022

Page: [771 - 777] Pages: 7

DOI: 10.2174/1381612828666220418090928

Price: $65

Abstract

Venous thromboembolism (VTE) is a serious complication after major orthopaedic operations, such as a total hip (THA) and knee (TKA) arthroplasty. Therefore, perioperative VTE prophylaxis is recommended; a multitude of modern options are available, including both pharmacologic (aspirin, unfractionated and lowmolecular- weight heparin, vitamin K antagonists, and novel oral anticoagulants) and/or mechanical interventions (early mobilization, graduated compression stockings, intermittent pneumatic compression devices, and venous foot pumps). However, because of the abundance of these possibilities, it is crucial to understand the benefits and drawbacks of each VTE prophylaxis option to ensure that the optimal treatment plan is developed for each patient. The American College of Chest Physicians (AACP) and the American Academy of Orthopaedic Surgeons (AAOS) have both published individual guidelines on VTE prophylaxis regimens, alongside numerous studies evaluating the efficacy and outcomes of the different prophylaxis modalities. The purpose of this review is to provide a summary of the evidence on VTE prophylaxis after elective total hip and knee arthroplasty based on current guidelines and highlight the major concerns and potential complications.

Keywords: Pharmaceutical prophylaxis, venous thromboembolism, total hip and total knee arthroplasty, vitamin K antagonists, oral anticoagulants, hematoma.

« Previous Next »
[1]
Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American college of chest physicians evidence- based clinical practice guidelines (8th Edition). Chest In: 2008; 133: pp. (6)381S-453S.
[http://dx.doi.org/10.1378/chest.08-0656] [PMID: 18574271]
[2]
Warren JA, Sundaram K, Kamath AF, et al. Venous thromboembolism rates did not decrease in lower extremity revision total joint arthroplasty from 2008 to 2016. J Arthroplasty 2019; 34(11): 2774-9.
[http://dx.doi.org/10.1016/j.arth.2019.05.012] [PMID: 31153709]
[3]
Boylan MR, Perfetti DC, Kapadia BH, Delanois RE, Paulino CB, Mont MA. Venous thromboembolic disease in revision vs. primary total knee arthroplasty. J Arthroplasty 2017; 32(6): 1996-9.
[http://dx.doi.org/10.1016/j.arth.2016.12.051] [PMID: 28209273]
[4]
Olson JJ, Schwab P-E, Jackson J, Lange JK, Bedair HS, Abdeen A. HIV-positive patients are at increased risk of venous thromboembolism after total joint replacement. J Am Acad Orthop Surg 2021; 29: 479-85.
[http://dx.doi.org/10.5435/JAAOS-D-20-00737]
[5]
Parvizi J, Huang R, Rezapoor M, Bagheri B, Maltenfort MG. Individualized risk model for venous thromboembolism after total joint arthroplasty. J Arthroplasty 2016; 31(9): 180-6.
[http://dx.doi.org/10.1016/j.arth.2016.02.077] [PMID: 27094244]
[6]
Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: An update. EFORT Open Rev 2018; 3(4): 136-48.
[http://dx.doi.org/10.1302/2058-5241.3.170018] [PMID: 29780621]
[7]
Falck-Ytter Y, Francis CW, Johanson NA, et al. 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 In: 2012; 141: pp. e278S-325S.
[http://dx.doi.org/10.1378/chest.11-2404]
[8]
Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100(17): 1455-60.
[http://dx.doi.org/10.2106/JBJS.17.01617] [PMID: 30180053]
[9]
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89(4): 780-5.
[http://dx.doi.org/10.2106/00004623-200704000-00012] [PMID: 17403800]
[10]
Shahi A, Chen AF, Tan TL, Maltenfort MG, Kucukdurmaz F, Parvizi J. The incidence and economic burden of in-hospital venous thromboembolism in the United States. J Arthroplasty 2017; 32(4): 1063-6.
[http://dx.doi.org/10.1016/j.arth.2016.10.020] [PMID: 27866951]
[11]
Poultsides LA, Gonzalez Della Valle A, Memtsoudis SG, et al. Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens. J Bone Joint Surg Br 2012; 94(1): 113-21.
[http://dx.doi.org/10.1302/0301-620X.94B1.27301] [PMID: 22219258]
[12]
Mont MA, Jacobs JJ, Boggio LN, et al. AAOS. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 2011; 19(12): 768-76.
[http://dx.doi.org/10.5435/00124635-201112000-00007] [PMID: 22134209]
[13]
White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med 1998; 158(14): 1525-31.
[http://dx.doi.org/10.1001/archinte.158.14.1525] [PMID: 9679793]
[14]
Klemen ND, Feingold PL, Hashimoto B, et al. Mortality risk associated with venous thromboembolism: A systematic review and Bayesian meta-analysis. Lancet Haematol 2020; 7(8): e583-93.
[http://dx.doi.org/10.1016/S2352-3026(20)30211-8] [PMID: 32735837]
[15]
Jenny J-Y, Bulaid Y, Boisrenoult P, Bonin N, Henky P, Tracol P, et al. Risques thrombotique et hémorragique de la prophylaxie antithrombotique conventionnelle après prothèse totale de hanche et de genou incluses dans une procédure de récupération accélérée. Rev Chir Orthopédique Traumatol 2020; 106: 971-7.
[http://dx.doi.org/10.1016/j.rcot.2020.10.018]
[16]
Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 2015; 313(5): 483-95.
[http://dx.doi.org/10.1001/jama.2014.18614] [PMID: 25647204]
[17]
Quintero JI, Cárdenas LL, Navas M, Bautista MP, Bonilla GA, Llinás AM. Clinical care program in joint replacement surgery. primary joint arthroplasty surgery: Is the risk of major bleeding higher in elderly patients? a retrospective cohort study. J Arthroplasty 2016; 31(10): 2264-8.
[http://dx.doi.org/10.1016/j.arth.2016.03.025] [PMID: 27137092]
[18]
Slover J, Lavery JA, Schwarzkopf R, Iorio R, Bosco J, Gold HT. Incidence and risk factors for blood transfusion in total joint arthroplasty: Analysis of a statewide database. J Arthroplasty 2017; 32(9): 2684-2687.e1.
[http://dx.doi.org/10.1016/j.arth.2017.04.048] [PMID: 28579446]
[19]
Kesler KK, Brown TS, Martin JR, Springer BD, Otero J. Risk factors for blood transfusion after primary total hip arthroplasty. Reconstr Rev 2019; 9.
[http://dx.doi.org/10.15438/rr.9.1.226]
[20]
van der Veen L, Segers M, van Raay JJ, et al. Bleeding complications of thromboprophylaxis with dabigatran, nadroparin or rivaroxaban for 6 weeks after total knee arthroplasty surgery: A randomised pilot study. BMJ Open 2021; 11(1)e040336
[http://dx.doi.org/10.1136/bmjopen-2020-040336] [PMID: 33462096]
[21]
Leme LEG, Sguizzatto GT. Prophylaxis of venous thromboembolism in orthopaedic surgery. Rev Bras Ortop Engl 2012; 47: 685-93.
[http://dx.doi.org/10.1016/S2255-4971(15)30023-9]
[22]
Santana DC, Hadad MJ, Emara A, et al. Perioperative management of chronic antithrombotic agents in elective hip and knee arthroplasty. Medicina (Kaunas) 2021; 57(2): 188.
[http://dx.doi.org/10.3390/medicina57020188] [PMID: 33672130]
[23]
Venous thromboembolism in over 16s: Reducing the risk of hospital- acquired deep vein thrombosis or pulmonary embolism. London: National Institute for Health and Care Excellence (NICE); 2019 Aug 13.
[24]
Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K. What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med 1997; 157(5): 513-20.
[http://dx.doi.org/10.1001/archinte.1997.00440260055009] [PMID: 9066455]
[25]
Awtry EH, Loscalzo J. Aspirin. Circulation 2000; 101(10): 1206-18.
[http://dx.doi.org/10.1161/01.CIR.101.10.1206] [PMID: 10715270]
[26]
Undas A, Brummel-Ziedins KE, Mann KG. Antithrombotic properties of aspirin and resistance to aspirin: Beyond strictly antiplatelet actions. Blood 2007; 109(6): 2285-92.
[http://dx.doi.org/10.1182/blood-2006-01-010645] [PMID: 17148593]
[27]
An VVG, Phan K, Levy YD, Bruce WJM. Aspirin as thromboprophylaxis in hip and knee arthroplasty: A systematic review and meta-analysis. J Arthroplasty 2016; 31(11): 2608-16.
[http://dx.doi.org/10.1016/j.arth.2016.04.004] [PMID: 27178011]
[28]
Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med 2018; 378(8): 699-707.
[http://dx.doi.org/10.1056/NEJMoa1712746] [PMID: 29466159]
[29]
Faour M, Piuzzi NS, Brigati DP, et al. No difference between low- and regular-dose aspirin for venous thromboembolism prophylaxis after THA. Clin Orthop Relat Res 2019; 477(2): 396-402.
[http://dx.doi.org/10.1097/CORR.0000000000000613] [PMID: 30624322]
[30]
Tang A, Zak SG, Waren D, et al. Low-dose aspirin is safe and effective for venous thromboembolism prevention in patients undergoing revision total knee arthroplasty: A retrospective cohort study. J Knee Surg 2020; s-0040-s-1716377.
[http://dx.doi.org/10.1055/s-0040-1716377] [PMID: 32898907]
[31]
Parvizi J, Huang R, Restrepo C, et al. Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: A preliminary analysis. J Bone Joint Surg Am 2017; 99(2): 91-8.
[http://dx.doi.org/10.2106/JBJS.16.00147] [PMID: 28099298]
[32]
Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest In: 2008; 133: pp. (6)160S-98SM.
[http://dx.doi.org/10.1378/chest.08-0670] [PMID: 18574265]
[33]
Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest In: 2012; 141: pp. (2)e152S-84S.
[http://dx.doi.org/10.1378/chest.11-2295] [PMID: 22315259]
[34]
Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126(3): 188S-203S.
[http://dx.doi.org/10.1378/chest.126.3_suppl.188S] [PMID: 15383472]
[35]
Garcia DA, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants. Chest 2012; 141(2): e24S-43S.
[http://dx.doi.org/10.1378/chest.11-2291] [PMID: 22315264]
[36]
Levine RL, McCollum D, Hursting MJ. How frequently is venous thromboembolism in heparin-treated patients associated with heparin-induced thrombocytopenia? Chest 2006; 130(3): 681-7.
[http://dx.doi.org/10.1378/chest.130.3.681] [PMID: 16963663]
[37]
Hirsh J, Raschke R, Warkentin TE, Dalen JE, Deykin D, Poller L. Heparin: Mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest 1995; 108(4): 258S-75S.
[http://dx.doi.org/10.1378/chest.108.4_Supplement.258S] [PMID: 7555181]
[38]
Palmer AJ, Koppenhagen K, Kirchhof B, Weber U, Bergemann R. Efficacy and safety of low molecular weight heparin, unfractionated heparin and warfarin for thrombo-embolism prophylaxis in orthopaedic surgery: A meta-analysis of randomised clinical trials. Haemostasis 1997; 27(2): 75-84.
[http://dx.doi.org/10.1159/000217437] [PMID: 9212355]
[39]
Howard AW, Aaron SD. Low molecular weight heparin decreases proximal and distal deep venous thrombosis following total knee arthroplasty. A meta-analysis of randomized trials. Thromb Haemost 1998; 79(5): 902-6.
[http://dx.doi.org/10.1055/s-0037-1615090] [PMID: 9609217]
[40]
Bergqvist D, Benoni G, Björgell O, et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 1996; 335(10): 696-700.
[http://dx.doi.org/10.1056/NEJM199609053351002] [PMID: 8703168]
[41]
Rachidi S, Aldin ES, Greenberg C, Sachs B, Streiff M, Zeidan AM. The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery. Expert Rev Hematol 2013; 6(6): 677-95.
[http://dx.doi.org/10.1586/17474086.2013.853430] [PMID: 24219550]
[42]
Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest In: 2012; 141: pp. (2)e44S-88S.
[http://dx.doi.org/10.1378/chest.11-2292] [PMID: 22315269]
[43]
Papadopoulos DV, Kostas-Agnantis I, Gkiatas I, Tsantes AG, Ziara P, Korompilias AV. The role of new oral anticoagulants in orthopaedics: An update of recent evidence. Eur J Orthop Surg Traumatol 2017; 27(5): 573-82.
[http://dx.doi.org/10.1007/s00590-017-1940-x] [PMID: 28314985]
[44]
Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P. ADVANCE-2 investigators.Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): A randomised double-blind trial. Lancet 2010; 375(9717): 807-15.
[http://dx.doi.org/10.1016/S0140-6736(09)62125-5] [PMID: 20206776]
[45]
Azboy I, Groff H, Goswami K, Vahedian M, Parvizi J. Low-dose aspirin is adequate for venous thromboembolism prevention following total joint arthroplasty: A systematic review. J Arthroplasty 2020; 35(3): 886-92.
[http://dx.doi.org/10.1016/j.arth.2019.09.043] [PMID: 31733981]
[46]
Sheth NP, Lieberman JR, Della Valle CJ. DVT prophylaxis in total joint reconstruction. Orthop Clin North Am 2010; 41(2): 273-80.
[http://dx.doi.org/10.1016/j.ocl.2010.02.001] [PMID: 20399366]
[47]
Leclerc JR, Geerts WH, Desjardins L, et al. Prevention of venous thromboembolism after knee arthroplasty. A randomized, double-blind trial comparing enoxaparin with warfarin. Ann Intern Med 1996; 124(7): 619-26.
[http://dx.doi.org/10.7326/0003-4819-124-7-199604010-00001] [PMID: 8607589]
[48]
Fitzgerald RH Jr, Spiro TE, Trowbridge AA, et al. Enoxaparin Clinical Trial Group. Prevention of venous thromboembolic disease following primary total knee arthroplasty. A randomized, multicenter, open-label, parallel-group comparison of enoxaparin and warfarin. J Bone Joint Surg Am 2001; 83(6): 900-6.
[http://dx.doi.org/10.2106/00004623-200106000-00012] [PMID: 11407799]
[49]
Agaba P, Kildow BJ, Dhotar H, Seyler TM, Bolognesi M. Comparison of postoperative complications after total hip arthroplasty among patients receiving aspirin, enoxaparin, warfarin, and factor Xa inhibitors. J Orthop 2017; 14(4): 537-43.
[http://dx.doi.org/10.1016/j.jor.2017.08.002] [PMID: 28878512]
[50]
Holderness BM, Goto Y, McKernan L, Bernini P, Ornstein DL. Thromboprophylaxis and outcomes for total joint arthroplasty in congenital bleeding disorders: A single-center experience. Clin Appl Thromb Off J Int Acad Clin Appl Thromb 2016; 22(6): 563-8.
[http://dx.doi.org/10.1177/1076029616643821] [PMID: 27099385]
[51]
Pathak N, Munger AM, Charifa A, et al. Total knee arthroplasty in hemophilia A. Arthroplast Today 2020; 6(1): 52-58.e1.
[http://dx.doi.org/10.1016/j.artd.2019.12.008] [PMID: 32211475]
[52]
Peng HM, Wang LC, Zhai JL, et al. Incidence of symptomatic venous thromboembolism in patients with hemophilia undergoing hip and knee joint replacement without chemoprophylaxis: A retrospective study. Orthop Surg 2019; 11(2): 236-40.
[http://dx.doi.org/10.1111/os.12444] [PMID: 30932356]
[53]
Raza S, Kale G, Kim D, et al. Thromboprophylaxis and incidence of venous thromboembolism in patients with hemophilia A or B who underwent high-risk orthopedic surgeries. Clin Appl Thromb 2016; 22(2): 161-5.
[http://dx.doi.org/10.1177/1076029614543139] [PMID: 25008348]
[54]
Hughes LD, Lum J, Mahfoud Z, Malik RA, Anand A, Charalambous CP. Comparison of surgical site infection risk between warfarin, LMWH, and aspirin for venous thromboprophylaxis in TKA or THA: A systematic review and meta-analysis. JBJS Rev 2020; 8: e20.00021.
[http://dx.doi.org/10.2106/JBJS.RVW.20.00021]
[55]
Huang R, Buckley PS, Scott B, Parvizi J, Purtill JJ. Administration of aspirin as a prophylaxis agent against venous thromboembolism results in lower incidence of periprosthetic joint infection. J Arthroplasty 2015; 30(9): 39-41.
[http://dx.doi.org/10.1016/j.arth.2015.07.001] [PMID: 26182982]
[56]
Chahal GS, Saithna A, Brewster M, et al. A comparison of complications requiring return to theatre in hip and knee arthroplasty patients taking enoxaparin versus rivaroxaban for thromboprophylaxis. Ortop Traumatol Rehabil 2013; 15(2): 125-9.
[http://dx.doi.org/10.5604/15093492.1045953] [PMID: 23652532]
[57]
Jensen CD, Steval A, Partington PF, Reed MR, Muller SD. Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban: A retrospective cohort study. J Bone Joint Surg Br 2011; 93(1): 91-5.
[http://dx.doi.org/10.1302/0301-620X.93B1.24987] [PMID: 21196550]
[58]
Brimmo O, Glenn M, Klika AK, Murray TG, Molloy RM, Higuera CA. Rivaroxaban use for thrombosis prophylaxis is associated with early periprosthetic joint infection. J Arthroplasty 2016; 31(6): 1295-8.
[http://dx.doi.org/10.1016/j.arth.2015.12.027] [PMID: 26796776]
[59]
Kahlenberg CA, Richardson SS, Schairer WW, Sculco PK. Type of anticoagulant used after total knee arthroplasty affects the rate of knee manipulation for postoperative stiffness. J Bone Joint Surg Am 2018; 100(16): 1366-72.
[http://dx.doi.org/10.2106/JBJS.17.01110] [PMID: 30106817]
[60]
Walton NP, Jahromi I, Dobson PJ, Angel KR, Lewis PL, Campbell DG. Arthrofibrosis following total knee replacement; does therapeutic warfarin make a difference? Knee 2005; 12(2): 103-6.
[http://dx.doi.org/10.1016/j.knee.2004.06.004] [PMID: 15749444]
[61]
Keays AC, Mason M, Keays SL, Newcombe PA. The effect of anticoagulation on the restoration of range of motion after total knee arthroplasty: enoxaparin versus aspirin. J Arthroplasty 2003; 18(2): 180-5.
[http://dx.doi.org/10.1054/arth.2003.50024] [PMID: 12629608]
[62]
Sidhu VS, Graves SE, Buchbinder R, et al. CRISTAL: Protocol for a cluster randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study. BMJ Open 2019; 9(11) :e031657.
[http://dx.doi.org/10.1136/bmjopen-2019-031657] [PMID: 31699735]
[63]
Muscatelli SR, Charters MA, Hallstrom BR. Time for an update? a look at current guidelines for venous thromboembolism prophylaxis after hip and knee arthroplasty and hip fracture. Arthroplast Today 2021; 10: 105-7.
[http://dx.doi.org/10.1016/j.artd.2021.06.015] [PMID: 34337116]

Rights & Permissions Print Cite
Article Metrics
100
3
World Health Day
© 2024 Bentham Science Publishers | Privacy Policy