Prophylaxis for thromboembolic disease and evaluation for thrombophilia.
Patients treated with total hip or knee arthroplasty are at risk for venous thromboembolic disease. Laboratory evaluation of thrombophilia can help to better identify patients at higher risk for venous thromboembolic disease, and newer methods that test for genetic factors continue to evolve; however, more research is needed to justify routine testing for thrombophilia. Research studies have yielded differing results in determining the most appropriate prophylactic regimen. Both pharmaceutical and mechanical treatments are commonly used for prophylaxis. New pharmacologic prophylaxes include the Xa inhibitor rivaroxaban and the thrombin inhibitor dabigatran etexilate. The newest mechanical device used to prevent venous thromboembolism is a miniature, mobile, battery-operated pneumatic system called Continuous Enhanced Circulation Therapy. The American College of Chest Physicians guidelines and the American Academy of Orthopaedic Surgeons clinical guideline were reviewed to directly compare specific agents and balance the risks of venous thromboembolism. Future studies for venous thromboembolic prophylaxis will continue to evaluate new oral agents, improved pneumatic compression devices, and improved methods to decrease bleeding in the immediate postoperative period.
Orthopedic Surgeon, Department of Total Joint Replacement, Hospital for Special Surgery, New York, New York.
Geoffrey H
GH
Westrich
Jeffrey S
JS
Dlott
Fred D
FD
Cushner
Norman A
NA
Johanson
Allison V
AV
Ruel
D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants