title: Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty.
abstract: This guideline supersedes a prior one from 2007 on a similar topic. The work group evaluated the available literature concerning various aspects of patient screening, risk factor assessment, and prophylactic treatment against venous thromboembolic disease (VTED), as well as the use of postoperative mobilization, neuraxial agents, and vena cava filters. The group recommended further assessment of patients who have had a previous venous thromboembolism but not for other potential risk factors. Patients should be assessed for known bleeding disorders, such as hemophilia, and for the presence of active liver disease. Patients who are not at elevated risk of VTED or for bleeding should receive pharmacologic prophylaxis and mechanical compressive devices for the prevention of VTED. The group did not recommend specific pharmacologic agents and/or mechanical devices. The work group recommends, by consensus opinion, early mobilization for patients following elective hip and knee arthroplasty. The use of neuraxial anesthesia can help limit blood loss but was not found to affect the occurrence of VTED. No clear evidence was established regarding whether inferior vena cava filters can prevent pulmonary embolism in patients who have a contraindication to chemoprophylaxis and/or known VTED.
authors: Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA.
authors: Michael A
authors: MA
authors: Mont
authors: Joshua J
authors: JJ
authors: Jacobs
authors: Lisa N
authors: LN
authors: Boggio
authors: Kevin John
authors: KJ
authors: Bozic
authors: Craig J
authors: CJ
authors: Della Valle
authors: Stuart Barry
authors: SB
authors: Goodman
authors: Courtland G
authors: CG
authors: Lewis
authors: Adolph J
authors: AJ
authors: Yates
authors: William Charles
authors: WC
authors: Watters
authors: Charles M
authors: CM
authors: Turkelson
authors: Janet L
authors: JL
authors: Wies
authors: Patrick
authors: P
authors: Donnelly
authors: Nilay
authors: N
authors: Patel
authors: Patrick
authors: P
authors: Sluka
mesh_terms: D000767:Anesthesia, Epidural; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical; D015897:Comorbidity; D004434:Early Ambulation; D017558:Elective Surgical Procedures; D006467:Hemophilia A / Q000453:epidemiology; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging