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VTE PREVENTION: UNDERSTANDING CURRENT STRATEGIES

Today's Options for Thromboprophylaxis

Anticoagulants and Mechanical Thromboprophylaxis
Devices

For postsurgical orthopedic patients, specifically in cases of total hip replacement (THR) and total knee replacement (TKR), current American College of Chest Physicians (ACCP) and American Academy of Orthopaedic Surgeons (AAOS) guidelines recommend pharmacologic and mechanical thromboprophylaxis as standard options for VTE prevention.1,2

A review of the most recent ACCP and AAOS guidelines offers key insights into the efficacy and limitations of current strategies of VTE prophylaxis.

  • Anticoagulants are the cornerstones of thromboprophylaxis for VTE. A large number of randomized clinical trials provides evidence that appropriately used thromboprophylaxis reduces the incidence of VTE.1
  • Mechanical thromboprophylaxis devices, including graduated compression stockings, intermittent pneumatic compression, and venous foot pumps, are recommended by current guidelines in patients at high risk of bleeding, or as an adjunct to anticoagulant-based prophylaxis; however, these devices are often associated with1,3:
    • Poor patient compliance
    • Considerable costs related to their purchase and maintenance


References:

  1. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133(suppl 6):381S-453S. doi:10.1378/chest.08-0656.
  2. American Academy of Orthopaedic Surgeons clinical guideline on prevention of pulmonary embolism in patients undergoing total hip or knee arthroplasty. http://www.aaos.org/Research/guidelines/PE_guideline.pdf. Published 2007. Accessed February 1, 2011.
  3. The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism 2008. US Department of Health and Human Services Web site. http://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdf. Accessed January 26, 2011.