J Knee Surg 2018; 31(07): 605-609
DOI: 10.1055/s-0038-1636907
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty

Hayden N. Box
1  Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Sean Shahrestani
1  Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Michael H. Huo
1  Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Further Information

Publication History

04 January 2018

28 January 2018

Publication Date:
07 March 2018 (eFirst)

Abstract

Venous thromboembolic disease (VTED) is a major cause of morbidity and mortality after total knee arthroplasty (TKA). Current VTED prophylaxis protocols consist of early mobilization, mechanical compression devices, and pharmacologic agents. Venous phasic flow-regulated below-knee devices are generally favored, but the optimal duration and method of mechanical prophylaxis is unknown. Risk stratification models have been developed to guide pharmacologic prophylaxis. For patients with standard VTED risk profile, aspirin has become increasingly popular. Recent studies have validated the efficacy, relatively low bleeding risks, and cost-effectiveness of aspirin in the patients with standard risk profile. Current evidence suggests that the newer oral anticoagulants, including the factor Xa and the direct thrombin inhibitors, are effective for the reduction of postoperative VTED but may be associated with increased bleeding and wound complication rates.