Ten-Year Trends in Venous Thromboembolism Prophylaxis at a High-Volume Arthroplasty Center

Abstract

Introduction: Venous thromboembolism (VTE) prophylaxis is the standard of care after total joint arthroplasty. However, there have been changes in the prevalence of certain medication classes used by institutions over time driven by the literature and national clinical practice guidelines. The purpose of this study was to analyze the patterns of VTE medications over the past 10 years at our institution. Methods: We identified 25,095 patients who underwent a primary total joint arthroplasty between 2012 and 2022. Medications for VTE prophylaxis included aspirin, warfarin, unfractioned heparin (UFH), low-molecular-weight heparin (LMWH), factor-Xa inhibitors (FXa), and antiplatelet agents different from aspirin and thrombin inhibitors. Tranexamic acid use was recorded. The rates of symptomatic VTE were calculated and categorized as deep vein thrombosis or pulmonary embolism. Results: Venous thromboembolism rates decreased from 1.1% in 2012 to 0.2% in 2022 and ranged between 0.4% and 1.2% during the ten-year period. Although VTE incidence decreased in the past 4 years, an isolated increase was noted in 2021(1%). In 2012, the use of aspirin, warfarin, FXa, and UFH were 52.1%, 30.7%, 0%, and 16.2%, respectively, whereas in 2022, the rates for the same medications were 83.3%, 0.3%, 10.4%, and 1.8%, respectively. The use of LMWH, thrombin inhibitors, and other antiplatelet agents had minimal variation, and none of these medications surpassed 5% during this period. The aspirin dose changed from 325 mg in 2012 (96.5%) to 81 mg in 2022 (98.8%). Similarly, TXA use increased from 30.8% in 2012 to 84.9% in 2022. Conclusion: In the past 10 years, our institution has transitioned from warfarin, UFH, and high-dose aspirin to low-dose aspirin and FXa, exhibiting acceptably low deep vein thrombosis and diminishing pulmonary embolism rates during that time.