https://doi.org/10.4081/btvb.2024.131
Venous thromboembolism prophylaxis in orthopedic surgery: a narrative review
Submitted: 15 March 2024
Accepted: 7 October 2024
Published: 13 December 2024
Accepted: 7 October 2024
Abstract Views: 870
PDF: 120
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Venous thromboembolism (VTE) is a major complication of orthopedic surgery and can lead to complications including pulmonary embolism, stroke, or even death. This narrative review aims to summarize current approaches to VTE prophylaxis for patients undergoing orthopedic surgery while also considering current trends in research surrounding potential updates to clinical recommendations and establishing a clear case for the role of patient-centered therapeutic approaches when looking to manage orthopedic postoperative VTE and associated complications. A narrative review was performed based on existing literature published on the topic of VTE prophylaxis in orthopedic surgery between the dates 1.1.2012 and 12.31.2023. Articles were searched for using a com- bination of four key terms combined with Boolean operators and were searched for on three major databases – Google Scholar, PubMed, and ScienceDirect. Findings were combined with and compared to recommendations from major relevant professional organizations. A wide variety of guidelines for both chemoprophylaxis and mechanical prophylaxis were considered, with findings of particular interest being support for industry-standard low-molecular-weight heparin (LMWH) and direct oral anticoagulant (DOAC) chemoprophylaxis, along with increased interest in aspirin. The evidence also supports mechanical prophylaxis in conjunction with chemoprophylaxis. Given that few validated VTE risk prediction score calculators exist, it is the recommendation of the authors to enhance risk stratification and personalized medicine by developing an orthopedic-specific risk assessment model to assist in decision-making, risk factor identification, and overall provision of comprehensive, personalized care designed to optimize quality of life and maximize management of orthopedic postoperative thromboembolic complications.
1. Shukla D, Patel SP, Clack L, et al. Retrospective analysis of trends in surgery volumes between 2016 and 2019 and impact of the insurance deductible: Cross-sectional study. Ann Med Surg (Lond) 2021;63:102176.
DOI: https://doi.org/10.1016/j.amsu.2021.02.022
2. Majima T, Oshima Y. Venous thromboembolism in major orthopedic surgery. J Nippon Med Sch 2021;88:268-72.
DOI: https://doi.org/10.1272/jnms.JNMS.2021_88-418
3. Lutsey PL, Windham BG, Misialek JR, et al. Long‐term association of venous thromboembolism with frailty, physical functioning, and quality of life: the atherosclerosis risk in communities study. J Am Heart Assoc 2020;9:e015656.
DOI: https://doi.org/10.1161/JAHA.119.015656
4. Huang J, Liu X, Wu Z, Ma Y. Quality of life status and influencing factors among patients with deep vein thrombosis. Patient Prefer Adherence 2022;16:949-56.
DOI: https://doi.org/10.2147/PPA.S353128
5. Wang H, Klok FA, Rosendaal FR, et al. Health-related quality of life after first venous thromboembolism in individuals aged 70 years and older. Res Pract Thromb Haemost 2023;7:102144.
DOI: https://doi.org/10.1016/j.rpth.2023.102144
6. Anderson DR, Morgano GP, Bennett C, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv 2019;3:3898-944.
DOI: https://doi.org/10.1182/bloodadvances.2019000975
7. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients. Chest 2012;141:e278S-e325S.
DOI: https://doi.org/10.1378/chest.11-2404
8. Stevens SM, Woller SC, Kreuziger LB, et al. Executive Summary. Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest 2021;1602247-59.
9. Mont MA, Jacobs JJ, Boggio LN, et al. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 2011:19:768-76.
DOI: https://doi.org/10.5435/00124635-201112000-00007
10. National Guideline Centre (UK). Venous thromboembolism in over 16s: Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE Guideline No 89. National Institute for Health and Care Excellence. 2018.
11. Diep R, García D. Does aspirin prevent venous thromboembolism? Hematology Am Soc Hematol Educ Program 2020;2020:634-41.
DOI: https://doi.org/10.1182/hematology.2020000150
12. Hasan SS, Sunter W, Ahmed N, et al. Venous thromboembolism prophylaxis in patients undergoing knee replacements: comparison of real-world outcomes. Int J Clin Pharm 2021;43:621-8.
DOI: https://doi.org/10.1007/s11096-020-01173-3
13. Matharu GS, Kunutsor SK, Judge A, et al. Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement. JAMA Intern Med 2020;180:376-84.
DOI: https://doi.org/10.1001/jamainternmed.2019.6108
14. Anderson DR, Dunbar MJ, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med 2018;378:699-707.
DOI: https://doi.org/10.1056/NEJMoa1712746
15. Pellegrini VD, Eikelboom JW, Evarts CM, et al. Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol. BMJ Open 2022;12:e060000.
DOI: https://doi.org/10.1136/bmjopen-2021-060000
16. Singjie LC, Halomoan R, Saleh I, et al. Clinical effectiveness and safety of aspirin and other anticoagulants for venous thromboembolism prophylaxis after major orthopedic surgery: a systematic review and meta-analysis of randomized clinical trials. EFORT Open Rev 2022;7:792-9.
DOI: https://doi.org/10.1530/EOR-22-0053
17. Dutta S, Chattopadhayay S, Dasgupta C, Sarkar S. Low molecular weight heparin: a practical approach in deep venous thrombosis in palliative care. Indian J Palliat Care 2011;17:143-5.
DOI: https://doi.org/10.4103/0973-1075.84536
18. Bern MM, Hazel D, Deeran E, et al. Low dose compared to variable dose Warfarin and to Fondaparinux as prophylaxis for thromboembolism after elective hip or knee replacement surgery; a randomized, prospective study. Thromb J 2015;13:32.
DOI: https://doi.org/10.1186/s12959-015-0062-0
19. Flevas DA, Megaloikonomos PD, Dimopoulos, et al. Thromboembolism prophylaxis in orthopaedics: An update. EFORT Open Rev 2018;3:136-48.
DOI: https://doi.org/10.1302/2058-5241.3.170018
20. Byon W, Garonzik S, Boyd RA, Frost CE. Apixaban: a clinical pharmacokinetic and pharmacodynamic review. Clin Pharmacokin 2019;58:1265-79.
DOI: https://doi.org/10.1007/s40262-019-00775-z
21. Rachidi S, Aldin ES, Greenberg C, et al. The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery. Expert Rev Hematol 2013;6:677-95.
DOI: https://doi.org/10.1586/17474086.2013.853430
22. Kubitza D, Berkowitz SD, Misselwitz F. Evidence-based development and rationale for once-daily rivaroxaban dosing regimens across multiple indications. Clin Appl Thromb Hemost 2016;22:412-22.
DOI: https://doi.org/10.1177/1076029616631427
23. GanetskyM, Babu KM, Salhanick SD, et al. Dabigatran: review of pharmacology and management of bleeding complications of this novel oral anticoagulant. J Med Toxicol 2011;7:281-7.
DOI: https://doi.org/10.1007/s13181-011-0178-y
24. Fuji T, Fujita S, Kawai Y, et al. Efficacy and safety of edoxaban versus enoxaparin for the prevention of venous thromboembolism following total hip arthroplasty: STARS J-V. Thromb J 2015;13:27.
DOI: https://doi.org/10.1186/s12959-015-0057-x
25. Fuji T, Fujita S, Tachibana S, Kawai Y. A dose‐ranging study evaluating the oral factor Xa inhibitor edoxaban for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty. J Thromb Haemost 2010;8:2458-68.
DOI: https://doi.org/10.1111/j.1538-7836.2010.04021.x
26. AlHajri L, Jabbari S, AlEmad H, et al. The efficacy and safety of edoxaban for VTE prophylaxis post-orthopedic surgery: a systematic review. J Cardiovasc Pharmacol Ther 2017;22:230-8.
DOI: https://doi.org/10.1177/1074248416675732
27. Faour M, Piuzzi NS. Brigat, DP, et al. Low-dose aspirin is safe and effective for venous thromboembolism prophylaxis following total knee arthroplasty. J Arthroplasty 2018;33:S131-5.
DOI: https://doi.org/10.1016/j.arth.2018.03.001
28. Kwak HS, Cho JH, Kim JT, et al. Intermittent pneumatic compression for the prevention of venous thromboembolism after total hip arthroplasty. Clin Orthop Surg 2017;9:37-42.
DOI: https://doi.org/10.4055/cios.2017.9.1.37
29. Aprisunadi, Nursalam N, Mustikasari M, et al. Effect of early mobilization on hip and lower extremity postoperative: a literature review. SAGE Open Nurs 2023:9:23779608231167825.
DOI: https://doi.org/10.1177/23779608231167825
30. Horner D, Pandor A, Goodacre S, et al. Individual risk factors predictive of venous thromboembolism in patients with temporary lower limb immobilization due to injury: a systematic review. J Thromb Haemost 2019;17:329-44.
DOI: https://doi.org/10.1111/jth.14367
31. Nemeth B, Lijfering WM, Nelissen RGHH, et al. Risk and risk factors associated with recurrent venous thromboembolism following surgery in patients with history of venous thromboembolism. JAMA Netw Open 2019;2:e193690.
DOI: https://doi.org/10.1001/jamanetworkopen.2019.3690
32. Zöller B, Svensson P, Sundquist J, et al. Postoperative joint replacement complications in Swedish patients with a family history of venous thromboembolism. JAMA Netw Open 2018;1:e181924.
DOI: https://doi.org/10.1001/jamanetworkopen.2018.1924
33. Trabulsi N, Khafagy AM, Alhazmi LS, , et al. Caprini versus Padua venous thromboembolism risk assessment scores. Saudi Med J 2024;45:362-8.
DOI: https://doi.org/10.15537/smj.2024.45.4.20230954
34. Gibbs B, Paek S, Wojciechowski N, et al. A comparison of the Caprini score with an institutional risk assessment tool for prediction of venous thromboembolism after total joint arthroplasty at an Urban Tertiary Care Health Safety Net hospital. Arthroplast Today 2023:23:101194.
DOI: https://doi.org/10.1016/j.artd.2023.101194
35. Januel JM, Chen G, Ruffieux C, et al. Symptomatic In-Hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis. JAMA 2012;307:294-303.
DOI: https://doi.org/10.1001/jama.2011.2029
36. Cote MP, Chen A, Jiang Y, et al. Persistent pulmonary embolism rates following total knee arthroplasty even with prophylactic anticoagulants. J Arthroplasty 2017;32:3833-9.
DOI: https://doi.org/10.1016/j.arth.2017.06.041
37. Harrington J, Piccini JP, Alexander JH, et al. Clinical evaluation of factor XIa inhibitor drugs: JACC review topic of the week. J Am Coll Cardiol 2023;81:771-9.
DOI: https://doi.org/10.1016/j.jacc.2022.11.057
38. Kunutsor SK, Beswick AD, Whitehouse MR, Blom AW. Systematic review of risk prediction scores for venous thromboembolism following joint replacement. Thromb Res 2018:168:148-55.
DOI: https://doi.org/10.1016/j.thromres.2018.06.024
39. Lavon O, Tamir Th. Evaluation of the Padua Prediction Score ability to predict venous thromboembolism in Israeli non-surgical hospitalized patients using electronic medical records. Sci Rep 2022;12:6121.
DOI: https://doi.org/10.1038/s41598-022-10209-9
40. Arakaki D, Iwata M, Terasawa T. External validation of the PaDUA and IMPROVE-VTE risk assessment models for predicting venous thromboembolism in hospitalized adult medical patients: a retrospective single-center study in Japan. Ann Vasc Dis 2023;16:60-8.
DOI: https://doi.org/10.3400/avd.oa.22-00108
How to Cite
Gallitto, S., Varkey, T. C., & Lahti, J. (2024). Venous thromboembolism prophylaxis in orthopedic surgery: a narrative review. Bleeding, Thrombosis and Vascular Biology, 3(3). https://doi.org/10.4081/btvb.2024.131
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Massimo Franchini, Polycythemia vera and management of the thrombotic risk: an update , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 4 (2023)
- Loredana Bury, Alessio Branchini, Francesco Bernardi, Paolo Gresele, Platelet transcriptomic changes in myocardial infarction are sex and clinical subtype-related: a step forward towards precision medicine? , Bleeding, Thrombosis and Vascular Biology: Vol. 4 No. 1 (2025)
- Rossana Corso, Andrea Coppola, Stefano Grazioli, Cristina Dedionigi, Nicolò Tandurella, Massimo Venturini, Francesco Dentali, Iatrogenic pseudoaneurysm of inferior epigastric artery: not only a surgical complication , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Loredana Bury, Paolo Gresele, The amazing genetic complexity of anucleated platelets , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Giovanni de Gaetano, Welcome to AICE and sincere wishes for peace for the new year 2024 , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 4 (2023)
- Tiziano Barbui, Clonal hematopoiesis and inflammation: a link with thrombosis and malignancy , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 2 (2022)
- Rossella Marcucci, Rosanna Abbate, What is the gender of thrombosis? A natural model of precision medicine , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Benedetta Izzi, Simona Costanzo, Alessandro Gialluisi, Amalia De Curtis, Sara Magnacca, Teresa Panzera, Augusto Di Castelnuovo, Maria Benedetta Donati, Chiara Cerletti, Marc F. Hoylaerts, Giovanni de Gaetano, Licia Iacoviello, *on behalf of the Moli-sani Study Investigators, Platelet distribution width is associated with cardiovascular mortality in an adult general population , Bleeding, Thrombosis and Vascular Biology: Vol. 2 No. 3 (2023)
- Giovanni de Gaetano, Well begun is half done , Bleeding, Thrombosis and Vascular Biology: Vol. 1 No. 3 (2022)
- Ottavia Borghese, Claudio Vincenzoni, Commentary on “Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicenter, open-label, randomized controlled trial” , Bleeding, Thrombosis and Vascular Biology: Vol. 3 No. 2 (2024)
You may also start an advanced similarity search for this article.
