Abstract
Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.
Highlights
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and effective procedures for treating end-stage osteoarthritis, with approximately one million procedures performed annually and more than seven million people living with joint replacements in the U.S [1,2,3,4,5].The complication rate for these elective operations is low, but major complications such as venous thromboembolism (VTE) can be highly debilitating due to increased length of stay, potentially worsened outcomes or mortality, and an additional cost of $15,000–30,000 per episode [6,7,8,9]
Compared to other major operations, VTE occurs at a higher rate in THA and TKA, pharmacologic prophylaxis for VTE is largely considered to be necessary in these procedures [10]
Given the significant burden of VTE in THA and TKA there has been considerable effort directed towards prevention, and we would expect that the rate of VTE should diminish over time
Summary
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and effective procedures for treating end-stage osteoarthritis, with approximately one million procedures performed annually and more than seven million people living with joint replacements in the U.S [1,2,3,4,5]. The complication rate for these elective operations is low, but major complications such as venous thromboembolism (VTE) can be highly debilitating due to increased length of stay, potentially worsened outcomes or mortality, and an additional cost of $15,000–30,000 per episode [6,7,8,9]. Compared to other major operations, VTE occurs at a higher rate in THA and TKA, pharmacologic prophylaxis for VTE is largely considered to be necessary in these procedures [10]. Understanding the current rate and trends in VTE is important in allowing clinicians to evaluate the overall success of recent interventions and guide future studies in this field. Given the numerous means of multimodal and pharmacologic prophylaxis for VTE available, it is important to have a concise guide of contemporary research in this area. THA and TKA and provides an update on pharmacologic VTE prophylaxis with a focus on the use of aspirin
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