ICJR Interviews: Do Patients Need Potent Anticoagulants to Prevent VTE?
It’s a given that joint replacement are at risk for venous thromboembolism (VTE) after surgery and require anticoagulant prophylaxis to prevent an occurrence.
What’s not a given is the type of anticoagulant that should be used. Is aspirin sufficient? Or do patients need something more powerful, such as warfarin or a low molecular weight heparin like enoxaparin?
And what role does the patient’s risk for VTE play in the decision?
That last point is important: Many orthopaedic surgeons reserve potent anticoagulants like enoxaparin for the highest-risk patients, even though these drugs are associated with adverse events such as wound complications and periprosthetic joint infection (PJI).
A multicenter study that involved more than 63,000 joint replacement patients from The Rothman Institute, the Cleveland Clinic, and the University of California, San Francisco suggests this strategy may be unnecessary.
Timothy Tan, MD, from The Rothman Institute, said the researchers split the patients into 3 groups based on the anticoagulants that were used – aspirin, warfarin, or potent anticoagulants (low molecular weight heparin and oral and intravenous Factor Xa inhibitors) – and then assigned a risk score to each patient based on a validated risk scoring system. 
The researchers found that aspirin was as effective as any of the other anticoagulants in preventing VTE, Dr. Tan said. What’s more, patients who received aspirin had the lowest risk of PJI.
Click on the image above to hear Dr. Tan discuss the study, “Efficacy of Venous Thromboembolism Prophylaxis in Total Joint Arthroplasty Based on Risk Stratification” (Poster 060), which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.
Producer: Susan Doan-Johnson; Director: Michael Bugera; Post Production: Charles J. Maynard
Bohl DD, Maltenfort MG, Huang R, Parvizi J, Lieberman JR, Della Valle CJ. Development and validation of a risk stratification system for pulmonary embolism after elective primary total joint arthroplasty. J Arthroplasty 2016 Mar 17. pii: S0883-5403(16)00285-0. doi: 10.1016/j.arth.2016.02.080. [Epub ahead of print]