Venous thromboembolism (VTE) prevention in orthopedics: facts, controversies, and evolving management

Jessica M Langer,¹ Alpesh Amin<sup>2

1</sup>Department of Medicine, University of California, Irvine, Irvine, CA, USA; ²University of California, Irvine Medical Center, Orange, CA, USA

Abstract: Multiple orthopedic procedures are performed each year including knee and hip replacements, also known as knee and hip arthroplasty. These procedures strongly activate the clotting cascade and increase the risk of venous thromboembolism (VTE). While everyone can agree that VTE is a serious and preventable problem following orthopedic surgery, not everyone agrees on best practice guidelines. This is compounded by the fact that there are multiple methods of VTE prevention including various chemoprophylactic and mechanical options as well as multiple organizations that have developed sometimes conflicting guidelines for VTE prevention including the American College of Chest Physicians and the American Academy of Orthopedic Surgery. The purpose of this paper is to present the available research on prominent chemoprophylactic VTE options for orthopedic surgery, examine and compare leading VTE prevention guidelines, and discuss the ramifications for noncompliance with industry standard guidelines.

Keywords: VTE prophylaxis, knee replacement, hip replacement