title: Risk-Stratified Venous Thromboembolism Prophylaxis After Total Joint Arthroplasty: Aspirin and Sequential Pneumatic Compression Devices vs Aggressive Chemoprophylaxis.
abstract: Venous thromboembolism (VTE) is a major concern after total joint arthroplasty (TJA). We evaluated a risk-stratified prophylaxis protocol for patients undergoing TJA.
  
  
  
  A total of 2611 TJA patients were retrospectively studied. Patients treated with an aggressive VTE chemoprophylaxis protocol were compared with patients treated with a risk-stratified protocol utilizing aspirin and sequential pneumatic compression devices (SPCDs) for standard-risk patients and targeted anticoagulation for high-risk patients.
  
  
  
  We found equivalence in terms of VTE prevention between the 2 cohorts. There was a decrease in adverse events and readmissions among the risk-stratified cohort, although this did not reach statistical significance. A statistically significant reduction in costs (P < .001) was experienced with the use of aspirin/SPCDs compared with aggressive anticoagulation agents within the risk-stratified cohort.
  
  
  
  The use of aspirin/SPCDs in a risk-stratified TJA population is a safe and cost-effective method of VTE prophylaxis.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Khalid
authors.initials: K
authors.lastname: Odeh
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Doran
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bolz
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bosco
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use*; D018890:Chemoprevention; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*
chemical_list: D000925:Anticoagulants; D001241:Aspirin
keywords: cost; deep venous thrombosis; pulmonary embolism; risk stratification; venous thromboembolism