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Current Concepts Review   |    
Prevention of Venous Thromboembolic Disease After Total Hip and Knee Arthroplasty
Jay R. Lieberman, MD1; Michael J. Pensak, MD2
1 Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo, HCT Suite 2000, Los Angeles, CA 90033
2 Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Avenue, MARB 4th floor, Farmington, CT 06034-4037
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Investigation performed at the University of Connecticut Health Center, Farmington, Connecticut, and the Keck School of Medicine of the University of Southern California, Los Angeles, California



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 02;95(19):1801-1811. doi: 10.2106/JBJS.L.01328
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Abstract

➤ The selection of a regimen for venous thromboembolic prophylaxis after total joint arthroplasty is a balance between efficacy and safety. Bleeding may have a negative impact on clinical outcomes.

➤ Recently, both the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) developed new evidence-based guidelines for venous thromboembolic prophylaxis after total joint arthroplasty.

➤ On the basis of a review of the available literature, the AAOS guideline panel was unable to make a recommendation with respect to the selection of a specific prophylaxis regimen or duration of prophylaxis following routine total joint arthroplasty.

➤ The ACCP panel recommended one of the following modalities as prophylaxis (rather than no prophylaxis at all) for a minimum of fourteen days: warfarin, low-molecular-weight heparin, fondaparinux, aspirin, rivaroxaban, dabigatran, apixaban, or portable mechanical compression.

➤ Both the AAOS and the ACCP guidelines recommended against screening with postoperative duplex ultrasonography at the time of discharge after routine total joint arthroplasty.

➤ There is renewed interest in the use of mechanical compression as prophylaxis with the advent of portable compression devices, which allow continuation of this type of prophylaxis after hospital discharge. Although the early data are promising, appropriately powered randomized trials are needed to determine the efficacy of the devices compared with other prophylaxis regimens.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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