A multimodality regimen for deep venous thrombosis prophylaxis in total knee arthroplasty

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

“…The optimum duration for VTE prophylaxis remains controversial because the appropriate length of aspirin prophylaxis after TJA is not well studied. The studies included in this systematic review reported various durations of aspirin prophylaxis including 14 days [28,29,46,50], 21 days [52,58], 3 weeks [51], 1 month/4 weeks [11,34,35,37,40,44], 5 weeks [32], and 6 weeks [3,7,15,22,23,25,26,31,38,39,42,43,53,54]. We found no significant difference between incidence of PE or DVT and the different durations of aspirin treatment examined (<4 weeks, 4 weeks, and >4 weeks).…”

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

“…Sachs et al [37] found twice as many wound problems (including superficial and deep infections and wound necrosis) in patients receiving warfarin postoperatively when compared to a control group not receiving any form of thromboprophylaxis after TKA. In contrast, several studies cite only a low risk of adverse bleeding events in patients receiving aspirin after TJA [27,36], while many have reported on clinically important bleeding risks associated with warfarin administration [15-17, 20, 22, 24-26, 29]. Sharrock et al [38] conducted a systematic review evaluating the association between anticoagulation regimens and all-cause mortality rates after TJA.…”

Is there not a better way to prevent venousthromboembolism after total knee arthroplasty?

“…Among total joint surgery complications, the risk of venous thromboembolism (VTE) is of the utmost concern warranting VTE prophylaxis in even low risk patients. Patients undergoing total knee arthroplasty (TKA) are particularly at risk for VTE with an incidence rate of 17-53 % depending on the method of prevention [1] therein warranting routine prevention in even low-risk patients [2][3][4][5][6][7]. Standard of care guidelines implemented by the American Academy of Orthopedic Surgeons (AAOS) has mandated a regimen of thromboprophylaxis for all total hip or knee replacement patients, and has outlined those regimens with updated research evidence, taking into account the patient's history and risk of thrombosis [2].…”

“…In a large level II evidence registry study, 3 060 total joint replacement patients receiving at least 10 days of MCD with or without aspirin were found to have similar incidence of VTE to patients receiving standard chemoprophylactics [3]. The AAOS recognizes that a surgeon may prefer to administer the safe and convenient aspirin over other common chemoprophylactic agents [7]. When using aspirin, the AAOS advises the addition of a mechanical compression device (MCD) to increase the efficacy of aspirin in VTE prevention [2].…”

“…MCDs have an assortment of modalities (figure) such as pneumatic compression or sequential compression; and while there is inconclusive evidence as to effectiveness between processes, MCDs are thought to influence Virchow's triad by reducing venous stasis, thereby reducing the incidence of DVT or PE [7,8]. When used in combination with the AAOS indicated antiplatelet agent, aspirin, adequate thromboprophylaxis may be obtained reducing the risk of debilitating side effects or severe bleeding associated with warfarin and other chemoprophylactics.…”