Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty

TLDR

This guideline updates a 2007 version and notes that evidence is unclear regarding the benefit of inferior vena cava filters for patients with contraindications to chemoprophylaxis or existing venous thromboembolism. The work group reviewed literature on patient screening, risk factor assessment, prophylactic treatment, postoperative mobilization, neuraxial agents, and vena cava filters. The group recommends assessing prior VTED and bleeding disorders, providing pharmacologic prophylaxis and mechanical devices to low‑risk patients, but does not endorse specific agents or devices; it also endorses early mobilization and notes neuraxial anesthesia reduces blood loss without affecting VTED risk.

Abstract

This guideline supersedes a prior one from 2007 on a similar topic. The work group evaluated the available literature concerning various aspects of patient screening, risk factor assessment, and prophylactic treatment against venous thromboembolic disease (VTED), as well as the use of postoperative mobilization, neuraxial agents, and vena cava filters. The group recommended further assessment of patients who have had a previous venous thromboembolism but not for other potential risk factors. Patients should be assessed for known bleeding disorders, such as hemophilia, and for the presence of active liver disease. Patients who are not at elevated risk of VTED or for bleeding should receive pharmacologic prophylaxis and mechanical compressive devices for the prevention of VTED. The group did not recommend specific pharmacologic agents and/or mechanical devices. The work group recommends, by consensus opinion, early mobilization for patients following elective hip and knee arthroplasty. The use of neuraxial anesthesia can help limit blood loss but was not found to affect the occurrence of VTED. No clear evidence was established regarding whether inferior vena cava filters can prevent pulmonary embolism in patients who have a contraindication to chemoprophylaxis and/or known VTED.