Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

Abstract

The risk of venous thromboembolism following total joint arthroplasty is significantly greater than those of other types of elective orthopaedic procedures. This risk is increased in obesity due to the associated prothrombotic physiological and hematological changes that predispose to embolic events. The prevalence of obesity is increasing in the aging population, which contributes to a further increase in the risk of postoperative thrombosis in the older patients. There is a lack of clear evidence regarding dosing information for thromboprophylaxis medications in patients with obesity. As a result, the currently available thromboprophylaxis guidelines do not provide specific recommendations for this group. Suboptimal dosing regimens for these medications can place these patients at a risk of bleeding or clotting complications postsurgery. Hence any increase in dosage may require intensive surveillance for the residual anticoagulant effects and careful balancing of risks and benefits on an individual basis. Our review discusses the basis for increased thrombotic risk in obesity, the evidence supporting dosage recommendations, and the implications of the current guidelines for pharmacological thromboprophylaxis in patients with obesity undergoing lower limb arthroplasty.

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“…It has no significant difference in the incidence of SVT among the two groups ( p = 0.489, Table 2). However, the guideline was published by the American Academy of Orthopedic Surgeons, which suggests using pharmacologic agents and/or mechanical compressive devices to prevent VTE in patients undergoing TKA as a moderate recommendation 7,8 . The American College of Chest Physicians recommends using one of the following for 10 to 35 days 9,10 .…”

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“…Indeed, various studies have shown the impact of obesity on the risk of venous thromboembolism (VTE). 3,4 While obesity per se is a risk, the added impact of prothrombotic genotypes has been reported from the Tromsø Study (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) and the Trøndelag Health Study (HUNT) (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). 5 In this issue of Thrombosis & Haemostasis, Frischmuth et al 6 report from Tromsø, Norway, a survey of 36,341 participants.…”

“…Indeed, various studies have shown the impact of obesity on the risk of venous thromboembolism (VTE). 3 4 While obesity per se is a risk, the added impact of prothrombotic genotypes has been reported from the Tromsø Study (1994–2012) and the Trøndelag Health Study (HUNT) (1995–2008). 5 In this issue of Thrombosis & Haemostasis , Frischmuth et al 6 report from Tromsø, Norway, a survey of 36,341 participants.…”

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