Aggressive Anticoagulation after TJA: An Evaluation of the ACCP Guidelines for Thromboprophylaxis

Abstract

Thromboembolic disease is common after orthopaedic surgery. In an effort to minimize the risk of pulmonary embolism and deep vein thrombosis (DVT), anticoagulation administration has become a common practice. Both the American College of Chest Physicians (ACCP) and the American Association of Orthopaedic Surgeons (AAOS) have published guidelines recommending antithrombotic protocols. The ACCP guidelines are excessive and do not adequately evaluate the complications resulting from aggressive anticoagulation. These complications include, but are not limited to, major and minor bleeding events, thrombocytopenia, subsequent periprosthetic infection, and complications with spinal or epidural anesthesia. The AAOS guidelines generated by a group of orthopedic surgeons evaluate the efficacy of various agents in preventing pulmonary embolus and not distal DVT. They differ from the AACP guidelines in some aspects. The AAOS guidelines accept the use of aspirin combined with mechanical compression devices, and low-dose warfarin therapy. We believe that the AAOS guidelines for thromboprophylaxis take into account all risks associated with anticoagulation therapy and may prove to be a safer option for our patients.