Rationale for thromboprophylaxis in lower joint arthroplasty.

Without prophylaxis, rates of deep vein thrombosis (DVT) after major orthopedic surgery range from 40% to 60%. Randomized clinical trials over the past 30 years have provided evidence that primary thromboprophylaxis reduces DVT, pulmonary embolism (PE), and fatal PE, and prophylaxis to prevent venous thromboembolism (VTE) in patients at risk has been ranked as the highest safety practice for hospitalized patients. Since 1986, some type of prophylaxis has been recommended for total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery. Orthopedic guidelines published in Chest provide a current evidence-based guide for prophylaxis for TKA, THA, and hip fracture surgery. In addition to following these recommendations for routine prophylaxis, surgeons should assess patients for additional VTE risk. Patients at higher risk may need more intense prophylaxis. Data from meta-analyses and placebo-controlled, blinded, randomized clinical trials have demonstrated little or no increase in rates of clinically important bleeding with prophylaxis.